Provider Demographics
NPI:1811990005
Name:NEWSOME, DEBORAH E (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:E
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-7993
Mailing Address - Country:US
Mailing Address - Phone:850-526-2412
Mailing Address - Fax:850-718-0383
Practice Address - Street 1:4979 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-7993
Practice Address - Country:US
Practice Address - Phone:850-526-2412
Practice Address - Fax:850-718-0383
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1903302363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306417400Medicaid
FLY051MXMedicare Oscar/Certification
Q10947Medicare UPIN