Provider Demographics
NPI:1932134673
Name:GAY, DEBORA COULAPIDES
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:COULAPIDES
Last Name:GAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 ISLAND LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7453
Mailing Address - Country:US
Mailing Address - Phone:904-264-1204
Mailing Address - Fax:904-264-1227
Practice Address - Street 1:1570 ISLAND LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-7453
Practice Address - Country:US
Practice Address - Phone:904-264-1204
Practice Address - Fax:904-264-1227
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA282535363LF0000X
FLARNP9314409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily