Provider Demographics
NPI:1689217572
Name:MOCK, DEBORAH (APRN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 MASON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6497
Mailing Address - Country:US
Mailing Address - Phone:813-784-2568
Mailing Address - Fax:
Practice Address - Street 1:1910 ORIENT RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-3354
Practice Address - Country:US
Practice Address - Phone:813-630-4673
Practice Address - Fax:813-630-4670
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9521889163W00000X, 163WA0400X
FL110219992084P0802X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry