Healthcare Provider Details

I. General information

NPI: 1740286756
Provider Name (Legal Business Name): DEANNA KINGSLEY SPRINGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 DUNLAWTON AVE
PORT ORANGE FL
32127-4239
US

IV. Provider business mailing address

740 DUNLAWTON AVE
PORT ORANGE FL
32127-4239
US

V. Phone/Fax

Practice location:
  • Phone: 386-763-1000
  • Fax: 386-481-6399
Mailing address:
  • Phone: 386-763-1000
  • Fax: 386-481-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME81902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: