Provider Demographics
NPI:1255808770
Name:PORTELA, DEBORAH IRENE (APRN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:IRENE
Last Name:PORTELA
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 1:540 PARKVUE VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5583
Mailing Address - Country:US
Mailing Address - Phone:931-908-5106
Mailing Address - Fax:
Practice Address - Street 1:1718 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2926
Practice Address - Country:US
Practice Address - Phone:615-642-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner