Provider Demographics
NPI:1508059049
Name:DEMARIA, DEBRA A
Entity Type:Individual
Prefix:PROF
First Name:DEBRA
Middle Name:A
Last Name:DEMARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:DEMARIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN-C
Mailing Address - Street 1:8614 E STATE ROAD 70
Mailing Address - Street 2:STE 200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3710
Mailing Address - Country:US
Mailing Address - Phone:941-727-1243
Mailing Address - Fax:
Practice Address - Street 1:8614 E STATE ROAD 70
Practice Address - Street 2:STE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-18
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9338988363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ737ZMedicare UPIN