Provider Demographics
NPI:1558673020
Name:FOURNIER, DEBBIE ANN
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:ANN
Last Name:FOURNIER
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 1:2808 SUN LAKE LOOP
Mailing Address - Street 2:APT.206
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2417
Mailing Address - Country:US
Mailing Address - Phone:228-760-1133
Mailing Address - Fax:
Practice Address - Street 1:2808 SUN LAKE LOOP
Practice Address - Street 2:APT.206
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2417
Practice Address - Country:US
Practice Address - Phone:228-760-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS146227252Y00000X
FL753086252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency