Healthcare Provider Details

I. General information

NPI: 1932028982
Provider Name (Legal Business Name): DEBORA FRA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 WATKINS ST
PACE FL
32571-2511
US

IV. Provider business mailing address

4553 WATKINS ST
PACE FL
32571-2511
US

V. Phone/Fax

Practice location:
  • Phone: 850-800-2772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: