Healthcare Provider Details

I. General information

NPI: 1871014290
Provider Name (Legal Business Name): MRS. DEBRA KAREN NEGRETE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA KAREN NEGRETE PT, MBA

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

IV. Provider business mailing address

400 CELEBRATION PL
CELEBRATION FL
34747-4970
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4003
  • Fax: 407-303-4303
Mailing address:
  • Phone:
  • Fax: 407-303-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number5721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: