Provider Demographics
NPI:1477855872
Name:DEKELES, GEORGE (APRN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:DEKELES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 4TH ST N # 352
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2322
Mailing Address - Country:US
Mailing Address - Phone:727-371-4357
Mailing Address - Fax:727-279-3456
Practice Address - Street 1:475 CENTRAL AVE # 300B
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3859
Practice Address - Country:US
Practice Address - Phone:727-371-4357
Practice Address - Fax:727-279-3456
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3020142363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health