Provider Demographics
NPI:1245984525
Name:SEALS, DERRICK DEVONNE (FNP)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:DEVONNE
Last Name:SEALS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 WAREHAM WAY
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-5631
Mailing Address - Country:US
Mailing Address - Phone:850-206-5159
Mailing Address - Fax:
Practice Address - Street 1:1872 WAREHAM WAY
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-5631
Practice Address - Country:US
Practice Address - Phone:850-206-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty