Healthcare Provider Details

I. General information

NPI: 1255254918
Provider Name (Legal Business Name): DEBORA RAMOS SIBAJA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 LAKE ALFRED RD
WINTER HAVEN FL
33881-1447
US

IV. Provider business mailing address

3545 LAKE ALFRED RD
WINTER HAVEN FL
33881-1447
US

V. Phone/Fax

Practice location:
  • Phone: 863-269-0173
  • Fax:
Mailing address:
  • Phone: 863-269-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11050708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: