MEDICARE: MRS. DEBORAH LYNN RENEGAR ARNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9178246	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013912542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH LYNN RENEGAR ARNP-C

Provider Business Mailing Address
First Line	:	4523 HALLAMVIEW LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 HALLAMVIEW LN
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1814
Country	:	US
Telephone Number	:	863-284-5941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2021

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