Healthcare Provider Details

I. General information

NPI: 1477468296
Provider Name (Legal Business Name): DEBRA LEE GUTIERREZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N WICKHAM RD
MELBOURNE FL
32935-8625
US

IV. Provider business mailing address

596 N WICKHAM RD APT 68
MELBOURNE FL
32935-8768
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-1200
  • Fax: 321-841-3678
Mailing address:
  • Phone: 862-977-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050050
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: