Provider Demographics
NPI:1982663712
Name:ROME, DEBRA A (ARNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:ROME
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 9190
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-9190
Mailing Address - Country:US
Mailing Address - Phone:386-274-0790
Mailing Address - Fax:386-274-0800
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5114
Practice Address - Country:US
Practice Address - Phone:386-274-0790
Practice Address - Fax:386-274-0800
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2514442363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306956700Medicaid
FL034783303Medicaid
FL034783303Medicaid
FLY4694AMedicare ID - Type Unspecified