Basic Information
| Provider Information | |||||||||
| NPI: | 1245296839 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHULTMAN | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 S ORLANDO AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327894870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078944693 | ||||||||
| FaxNumber: | 4072613869 | ||||||||
| Practice Location | |||||||||
| Address1: | 766 N SUN DR STE 3030 | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327462555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074442800 | ||||||||
| FaxNumber: | 4074442810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0300X | ARNP9371456 | FL | N | Nursing Service Providers | Registered Nurse | Nephrology | 363LA2200X | 900474 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | ARNP9371456 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7003891 | 05 | NC | MEDICAID | EIN | 01 | FL | 59-1561574 | OTHER |