Basic Information
| Provider Information | |||||||||
| NPI: | 1962538371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNM, ARNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HALL | ||||||||
| OtherFirstName: | DEBBIE | ||||||||
| OtherMiddleName: | S | ||||||||
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| OtherCredential: | ARNP, CNM | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1560 KINGSLEY AVENUE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641628 | ||||||||
| FaxNumber: | 9042648386 | ||||||||
| Practice Location | |||||||||
| Address1: | 1560 KINGSLEY AVENUE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641628 | ||||||||
| FaxNumber: | 9042648386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 05/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2053952 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 367A00000X | ARNP2053952 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LX0001X | ARNP2053952 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.