Provider Demographics
NPI:1912914078
Name:HENDREN, DEBRA A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:HENDREN
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:PO BOX 10549
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0549
Mailing Address - Country:US
Mailing Address - Phone:727-824-8181
Mailing Address - Fax:
Practice Address - Street 1:1344 22ND ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-2744
Practice Address - Country:US
Practice Address - Phone:901-481-4642
Practice Address - Fax:727-824-8150
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9427949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123327100Medicaid
WYBLUE CROSS OF WYOtherWY BLUE CROSS BLUE SHIELD
S99459Medicare UPIN
WYBLUE CROSS OF WYOtherWY BLUE CROSS BLUE SHIELD