MEDICARE: ABIGAIL DEBACKER MD, RD, CNSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	ND10756	FL

General Provider Information

NPI Number	:	1255179834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL DEBACKER MD, RD, CNSC

Provider Business Mailing Address
First Line	:	8415 POYDRAS LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 POYDRAS LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-1632
Country	:	US
Telephone Number	:	407-346-4181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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