Provider Demographics
NPI:1982250205
Name:REFUSE, DESTINY DEBORA COLEY (APRN)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:DEBORA COLEY
Last Name:REFUSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3668
Mailing Address - Country:US
Mailing Address - Phone:727-799-4150
Mailing Address - Fax:727-796-1845
Practice Address - Street 1:100 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3668
Practice Address - Country:US
Practice Address - Phone:727-799-4150
Practice Address - Fax:727-796-1845
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003699363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106806700Medicaid