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NPI Code Detail

MEDICARE: DEBORAH LEE RIDDLE CRNA

MEDICARE: DEBORAH LEE RIDDLE CRNA
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
1363L00000XNurse Practitioner2030702FL
2367500000XCertified Registered Nurse Anesthetist024011FL

General Provider Information

NPI Number : 1083801138
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH LEE RIDDLE CRNA
Provider Business Mailing Address
First Line : 2750 INDIAN RIVER BLVD
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-5225
Country : US
Telephone Number : 772-569-9500
Fax Number : 772-569-9507
Provider Business Practice Location Address
First Line : 2750 INDIAN RIVER BLVD
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-5225
Country : US
Telephone Number : 772-569-9500
Fax Number : 772-569-9507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2007
Last Update Date : 07/27/2009

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Directions to “ DEBORAH LEE RIDDLE CRNA” Practice Location

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