Provider Demographics
NPI:1891817755
Name:CORTEZ, DEBRA ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MILL ST
Mailing Address - Street 2:APT#1
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-4806
Mailing Address - Country:US
Mailing Address - Phone:215-620-5076
Mailing Address - Fax:
Practice Address - Street 1:725 E ERIE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1210
Practice Address - Country:US
Practice Address - Phone:215-427-6986
Practice Address - Fax:215-291-1715
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant