Provider Demographics
NPI:1013461813
Name:HALL, DEBRA ANNIECE (LPN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNIECE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 FLEETWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-7057
Mailing Address - Country:US
Mailing Address - Phone:850-879-5880
Mailing Address - Fax:
Practice Address - Street 1:212 FLEETWOOD AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-7057
Practice Address - Country:US
Practice Address - Phone:850-879-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1042331164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse