Healthcare Provider Details

I. General information

NPI: 1528469806
Provider Name (Legal Business Name): DEBORAH C BUENO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SIMMONS LOOP 4TH FLOOR
RIVERVIEW FL
33578-9498
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 813-302-8388
  • Fax: 813-302-8453
Mailing address:
  • Phone: 772-223-2832
  • Fax: 772-223-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9313233
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: