=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376366393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BISSAN DEBSI FMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 767 BLANDING BLVD STE 103
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32065-5788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-577-2651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1883 W ROYAL HUNTE DR STE 200A
-----------------------------------------------------
City | CEDAR CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84720-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-577-2651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------