Provider Demographics
NPI:1417234840
Name:HOOVER, DEBRA A (DPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:HOOVER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GUINEVERES RETREAT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6486
Mailing Address - Country:US
Mailing Address - Phone:615-472-1819
Mailing Address - Fax:
Practice Address - Street 1:119 GUINEVERES RETREAT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6486
Practice Address - Country:US
Practice Address - Phone:615-472-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6321183500000X
IL051.291743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist