Provider Demographics
NPI:1922075910
Name:VARNAM, DEBORAH COGGINS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:COGGINS
Last Name:VARNAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 VILLAGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470
Mailing Address - Country:US
Mailing Address - Phone:910-754-2273
Mailing Address - Fax:910-754-2254
Practice Address - Street 1:712 VILLAGE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-754-2273
Practice Address - Fax:910-754-2254
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC191089OtherMEDCOST
NC1001722OtherAETNA
NC7003823Medicaid
2599201CMedicare PIN
NC1001722OtherAETNA