Provider Demographics
NPI:1952487761
Name:BAXA-CONROY, DEBORA MARIE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:MARIE
Last Name:BAXA-CONROY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MRS
Other - First Name:DEBORA
Other - Middle Name:MARIE
Other - Last Name:BAXA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:1265 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6574
Mailing Address - Country:US
Mailing Address - Phone:772-567-6340
Mailing Address - Fax:772-567-3564
Practice Address - Street 1:1265 36TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6574
Practice Address - Country:US
Practice Address - Phone:772-567-6340
Practice Address - Fax:772-567-3564
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant