Healthcare Provider Details

I. General information

NPI: 1245296839
Provider Name (Legal Business Name): DEBRA S SHULTMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 N SUN DR STE 3030
LAKE MARY FL
32746-2555
US

IV. Provider business mailing address

807 S ORLANDO AVE SUITE C
WINTER PARK FL
32789-4870
US

V. Phone/Fax

Practice location:
  • Phone: 407-444-2800
  • Fax: 407-444-2810
Mailing address:
  • Phone: 407-894-4693
  • Fax: 407-261-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License NumberARNP9371456
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900474
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9371456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: