Doctor Name: | DEBRA FONSECA |
NPI Number: | 1073967287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP-C |
License Number: | ARNP9266321 |
Business Practice Address: | 11707 N Williams St Dunnellon, FL - 344325855 |
Business Phone Number: | 3524651919 |
Business Fax Number: | |
Mailing Address: | 11707 N Williams St, DUNNELLON |
State: | FL |
Postal Code: | 344325855 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/14/2016 |
NPI Last Update Date: | 04/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | ARNP9266321 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |