Healthcare Provider Details

I. General information

NPI: 1538290705
Provider Name (Legal Business Name): DEBRA JEAN VINCENT APRN, BC, AOCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY SUITE 400
EAST SYRACUSE NY
13057-9248
US

IV. Provider business mailing address

1001 W FAYETTE ST SUITE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-4112
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR133555
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: