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General NPI Number Information
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NPI Number | 1720069917
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Entity Type | Individual
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Provider Name | DEBRA JACKSON SAFRIT F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2664 COURT DRIVE SUITE A
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City | GASTONIA
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State | NC
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Zip | 28054-1449
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Country | US
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Telephone | 704-861-9030
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Fax | 704-833-1234
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Provider Business Mailing Address
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Address Line | 2664 COURT DRIVE SUITE A
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City | GASTONIA
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State | NC
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Zip | 28054-1449
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Country | US
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Telephone | 704-861-9030
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Fax | 704-833-1234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201734
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License Number State | NC
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