MEDICARE: MRS. DEBRA A HENDREN FNP

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	ARNP9427949	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	BLUE CROSS OF WY	OTHER	WY	WY BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912914078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA A HENDREN FNP

Provider Business Mailing Address
First Line	:	PO BOX 10549
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33733-0549
Country	:	US
Telephone Number	:	727-824-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 22ND ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-2744
Country	:	US
Telephone Number	:	901-481-4642
Fax Number	:	727-824-8150

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/28/2016

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