Provider Demographics
NPI:1356373641
Name:LIVINGSTON, DEBBRA ANNETTE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DEBBRA
Middle Name:ANNETTE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DEBBRA
Other - Middle Name:ANNETTE
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 100236
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:BOX 100236
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-0134
Practice Address - Fax:352-265-0539
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1855332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003099900Medicaid
FL305800000Medicaid
FLEN904ZMedicare PIN