Provider Demographics
NPI:1871014290
Name:NEGRETE, DEBRA KAREN
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAREN
Last Name:NEGRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:KAREN
Other - Last Name:NEGRETE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MBA
Mailing Address - Street 1:400 CELEBRATION PL
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-303-4303
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-4003
Practice Address - Fax:407-303-4303
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57212081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine