MEDICARE: MRS. DEBORAH A FRAZER ARNP

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1828882	FL
2	363LF0000X	Family Nurse Practitioner	1828882	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	:	1164498101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH A FRAZER ARNP

Provider Business Mailing Address
First Line	:	301 DR CARTER BLVD
Second Line	:
City	:	BUNNELL
State	:	FL
Zip	:	32110-6212
Country	:	US
Telephone Number	:	386-437-7350
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 DR CARTER BLVD
Second Line	:
City	:	BUNNELL
State	:	FL
Zip	:	32110-6212
Country	:	US
Telephone Number	:	386-437-7350
Fax Number	:

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/18/2023

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