Provider Demographics
NPI:1346613015
Name:WILCOX, DEBORAH (DOM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 N ATLANTIC AVE # 770-14
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5831
Mailing Address - Country:US
Mailing Address - Phone:321-394-8038
Mailing Address - Fax:
Practice Address - Street 1:130 N TROPICAL TRL
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4737
Practice Address - Country:US
Practice Address - Phone:321-394-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3626171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist