Provider Demographics
NPI:1861673402
Name:DEBRA HANLEY DPM PA
Entity Type:Organization
Organization Name:DEBRA HANLEY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:CMA (AAMA)
Authorized Official - Phone:352-332-8442
Mailing Address - Street 1:100 SW 75TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5779
Mailing Address - Country:US
Mailing Address - Phone:352-332-8442
Mailing Address - Fax:352-332-8443
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:STE 205
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-332-8442
Practice Address - Fax:352-332-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2070213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340163400Medicaid
FL65272AMedicare PIN
FL340163400Medicaid
FL5834480001Medicare NSC