Healthcare Provider Details

I. General information

NPI: 1871569806
Provider Name (Legal Business Name): DEBORAH ANNE PANCHELLA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S LEMON ST
BUNNELL FL
32110-6212
US

IV. Provider business mailing address

301 S LEMON ST PO BOX 847
BUNNELL FL
32110-6212
US

V. Phone/Fax

Practice location:
  • Phone: 386-437-7350
  • Fax: 386-437-8207
Mailing address:
  • Phone: 386-437-7350
  • Fax: 386-437-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP849572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: