Healthcare Provider Details

I. General information

NPI: 1245698166
Provider Name (Legal Business Name): DEBRA SCOTT I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 SW MARTIN DOWNS BLVD
PALM CITY FL
34990-2644
US

IV. Provider business mailing address

9486 SW PURPLE MARTIN WAY
STUART FL
34997-8967
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-6456
  • Fax:
Mailing address:
  • Phone: 817-422-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMA52620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: