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NPI Code Detail

MEDICARE: DEBORAH K PETERSON NP

MEDICARE:   DEBORAH K PETERSON  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
1363LA2200XAdult Health Nurse Practitioner71000238AIN
2363LA2200XAdult Health Nurse PractitionerAPRN11013139FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00971563OTHERINRR MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1841204005
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH K PETERSON NP
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-9100
Fax Number : 239-343-9108
Provider Business Practice Location Address
First Line : 9131 COLLEGE POINTE CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3245
Country : US
Telephone Number : 239-343-9100
Fax Number : 239-343-9108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 11/10/2021

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