Healthcare Provider Details

I. General information

NPI: 1699058263
Provider Name (Legal Business Name): DEBORAH SUSAN COON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR STE 1F
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-4500
  • Fax: 321-956-2539
Mailing address:
  • Phone: 321-434-1981
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN1560912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: