Healthcare Provider Details

I. General information

NPI: 1912425281
Provider Name (Legal Business Name): DEBORAH RENEE' HUTCHINSON DCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 07/21/2022
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 MANGROVE POINT RD
BRADENTON FL
34210-2128
US

IV. Provider business mailing address

4803 MANGROVE POINT ROAD
BRADENTON FL
34210-2128
US

V. Phone/Fax

Practice location:
  • Phone: 843-864-5018
  • Fax:
Mailing address:
  • Phone: 843-864-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number10316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: