Provider Demographics
NPI:1881649382
Name:GOETTELMAN, DEBORAH JEAN (MS, BC-ARNP, CDE)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:GOETTELMAN
Suffix:
Gender:F
Credentials:MS, BC-ARNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 KAPOK GRAND CIR
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3016
Mailing Address - Country:US
Mailing Address - Phone:727-320-0859
Mailing Address - Fax:
Practice Address - Street 1:BAY PINES VA HEALTHCARE SYSTEM
Practice Address - Street 2:10000 BAY PINES BOULEVARD
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1052
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1181602C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner