Provider Demographics
NPI:1467851493
Name:ANDERSON-DELAINE, DEBBIE-ANN PATRICE (ARNP)
Entity type:Individual
Prefix:
First Name:DEBBIE-ANN
Middle Name:PATRICE
Last Name:ANDERSON-DELAINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15155 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4272
Mailing Address - Country:US
Mailing Address - Phone:321-290-2430
Mailing Address - Fax:407-440-2767
Practice Address - Street 1:1400 N SEMORAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3562
Practice Address - Country:US
Practice Address - Phone:407-823-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3117292363LP0808X
FLARNP 3117292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP3117292OtherMEDICAL LICENSE
FL013076500Medicaid
FLHX844ZMedicare PIN