Provider Demographics
NPI:1770519647
Name:COLE, DEBRA MARTIN (PA-C)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARTIN
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 MONTEIGNE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4536
Mailing Address - Country:US
Mailing Address - Phone:850-603-0333
Mailing Address - Fax:850-484-8223
Practice Address - Street 1:530 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2019
Practice Address - Country:US
Practice Address - Phone:850-474-4775
Practice Address - Fax:850-484-8223
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL592-27570OtherBLUE CROSS BLUE SHIELD
FLY07YMOtherBLUE CROSS BLUE SHIELD
AL592-20524OtherBLUE CROSS BLUE SHIELD
FLY07YMOtherBLUE CROSS BLUE SHIELD