Provider Demographics
NPI:1295919520
Name:PETELLAT, DEBBIE ANN
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ANN
Last Name:PETELLAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NE 2ND ST LOT 11
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4251
Mailing Address - Country:US
Mailing Address - Phone:352-422-2547
Mailing Address - Fax:352-563-5450
Practice Address - Street 1:316 NE 2ND ST LOT 11
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4251
Practice Address - Country:US
Practice Address - Phone:352-422-2547
Practice Address - Fax:352-563-5450
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide