Healthcare Provider Details

I. General information

NPI: 1356886196
Provider Name (Legal Business Name): DESHALA FRAZIER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 SW DADE ST STE A
MADISON FL
32340-2363
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-1402
  • Fax: 850-973-1450
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9303538
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11028468
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: