Healthcare Provider Details

I. General information

NPI: 1053545418
Provider Name (Legal Business Name): DEBRA A VINCENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S MAIN ST STE 200
CLINTON IN
47842-2493
US

IV. Provider business mailing address

2723 S 7TH STREET STE A
TERRE HAUTE IN
47802-3558
US

V. Phone/Fax

Practice location:
  • Phone: 765-828-0750
  • Fax: 765-828-0753
Mailing address:
  • Phone: 812-238-1730
  • Fax: 812-242-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000293A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: