Provider Demographics
NPI:1518407899
Name:WESTBY, DEIDRA
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:WESTBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6007
Mailing Address - Country:US
Mailing Address - Phone:813-654-2273
Mailing Address - Fax:813-413-8563
Practice Address - Street 1:888 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6007
Practice Address - Country:US
Practice Address - Phone:813-654-2273
Practice Address - Fax:813-413-8563
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9222214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily