Basic Information
Provider Information | |||||||||
NPI: | 1528469806 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BUENO | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 417 | ||||||||
Address2: |   | ||||||||
City: | STUART | ||||||||
State: | FL | ||||||||
PostalCode: | 349950417 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7722232832 | ||||||||
FaxNumber: | 7722235653 | ||||||||
Practice Location | |||||||||
Address1: | 6901 SIMMONS LOOP | ||||||||
Address2: | 4TH FLOOR | ||||||||
City: | RIVERVIEW | ||||||||
State: | FL | ||||||||
PostalCode: | 335789498 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8133028388 | ||||||||
FaxNumber: | 8133028453 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/05/2014 | ||||||||
LastUpdateDate: | 07/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9313233 | FL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | RZFAL | 01 | FL | FLORIDA BLUE | OTHER | 018350000 | 05 | FL |   | MEDICAID |