Healthcare Provider Details

I. General information

NPI: 1982250205
Provider Name (Legal Business Name): DESTINY DEBORA COLEY REFUSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN ST STE 203
SAFETY HARBOR FL
34695-3668
US

IV. Provider business mailing address

100 MAIN ST STE 203
SAFETY HARBOR FL
34695-3668
US

V. Phone/Fax

Practice location:
  • Phone: 727-799-4150
  • Fax: 727-796-1845
Mailing address:
  • Phone: 727-799-4150
  • Fax: 727-796-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11003699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: