Provider Demographics
NPI:1376549048
Name:CONNER, DEBRA JOY NOGUERAS (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JOY NOGUERAS
Last Name:CONNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, PHD
Mailing Address - Street 1:1900 S MELLONVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-3541
Mailing Address - Country:US
Mailing Address - Phone:786-232-5994
Mailing Address - Fax:
Practice Address - Street 1:1900 S MELLONVILLE AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3541
Practice Address - Country:US
Practice Address - Phone:786-232-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2826612363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P071320001Medicare UPIN