Healthcare Provider Details

I. General information

NPI: 1013996644
Provider Name (Legal Business Name): DEBORAH K LANIUS MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS AVE 1 SOMDG
HURLBURT FIELD FL
32544-5613
US

IV. Provider business mailing address

7681 WHITE SANDS BLVD
NAVARRE FL
32566-7120
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-5221
  • Fax:
Mailing address:
  • Phone: 615-638-6241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007880
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: