Provider Demographics
NPI:1720069917
Name:SAFRIT, DEBRA JACKSON (FNP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JACKSON
Last Name:SAFRIT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 COURT DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1449
Mailing Address - Country:US
Mailing Address - Phone:704-861-9030
Mailing Address - Fax:704-833-1234
Practice Address - Street 1:2664 COURT DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1449
Practice Address - Country:US
Practice Address - Phone:704-861-9030
Practice Address - Fax:704-833-1234
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000947Medicaid
NC2808189Medicare ID - Type Unspecified
NC7000947Medicaid