Provider Demographics
NPI:1932728193
Name:PHILLIPS, DEBBIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22010 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-2048
Mailing Address - Country:US
Mailing Address - Phone:417-399-3298
Mailing Address - Fax:
Practice Address - Street 1:17121 RAINBOW TER
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-2107
Practice Address - Country:US
Practice Address - Phone:813-749-6907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021028708363LF0000X
FL11016742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty