Healthcare Provider Details

I. General information

NPI: 1861673402
Provider Name (Legal Business Name): DEBRA HANLEY DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SW 75TH ST STE 205
GAINESVILLE FL
32607-5779
US

IV. Provider business mailing address

100 SW 75TH ST STE 205
GAINESVILLE FL
32607-5779
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-8442
  • Fax: 352-332-8443
Mailing address:
  • Phone: 352-332-8442
  • Fax: 352-332-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO 2070
License Number StateFL

VIII. Authorized Official

Name: BEVERLY NASH
Title or Position: OFFICE MANAGER
Credential: CMA (AAMA)
Phone: 352-332-8442