Provider Demographics
NPI:1457312035
Name:SWEENEY, DEIRDRE E (NP)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:E
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 N SUNCOAST BLVD
Mailing Address - Street 2:SEVEN RIVERS REGIONAL MEDICAL CENTER
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-6712
Mailing Address - Country:US
Mailing Address - Phone:617-997-7467
Mailing Address - Fax:
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:SEVEN RIVERS REGIONAL MEDICAL CENTER
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:617-997-7467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252200363L00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0703419Medicaid
MAAA30382OtherHARVARD PILGRIM
MANP4571OtherBLUE CROSS
MA0703419Medicaid
MANP4571OtherBLUE CROSS