Provider Demographics
NPI:1497907547
Name:FULTON-FISETTE, DEBRA ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:FULTON-FISETTE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:QUINDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 810
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8987
Practice Address - Country:US
Practice Address - Phone:352-674-8700
Practice Address - Fax:352-674-8714
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2044462363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0055OtherBCBSFL
FLY0055OtherBCBSFL
FLY0055OtherBCBSFL
FLDC134ZMedicare PIN