Provider Demographics
NPI:1720274673
Name:GREEN, DEBRA LYNN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:GREEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:KORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1700 SOUTH FEDERAL HIGHWAY
Mailing Address - Street 2:CVS/MINUTE CLINIC
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316
Mailing Address - Country:US
Mailing Address - Phone:954-462-8185
Mailing Address - Fax:
Practice Address - Street 1:1700 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-462-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9192028363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI125ZMedicare PIN