Provider Demographics
NPI:1013382134
Name:DOWELL, DEBRA (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DOWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 N DIXIE FWY
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-6220
Mailing Address - Country:US
Mailing Address - Phone:386-663-3003
Mailing Address - Fax:386-663-3007
Practice Address - Street 1:912 N DIXIE FWY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-6220
Practice Address - Country:US
Practice Address - Phone:386-663-3003
Practice Address - Fax:386-663-3007
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2617612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2617612OtherMEDICAL LICENSE
FL017352600Medicaid
FLIO469ZMedicare PIN