MEDICARE: DEBBIE J AREVALO NP

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	363LF0000X	Family Nurse Practitioner	ARNP9251458	FL
2	363LF0000X	Family Nurse Practitioner	71008896A	IN

General Provider Information

NPI Number	:	1194234237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE J AREVALO NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 E PETTIT AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-3005
Country	:	US
Telephone Number	:	260-234-5400
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	07/21/2022

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