Provider Demographics
NPI:1194706937
Name:VERBEEK, DEBORAH RUTH (CFNP, MSN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RUTH
Last Name:VERBEEK
Suffix:
Gender:F
Credentials:CFNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25495 MAIN ST
Mailing Address - Street 2:PO BOX 746
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3155
Mailing Address - Country:US
Mailing Address - Phone:931-427-6969
Mailing Address - Fax:931-427-6967
Practice Address - Street 1:25495 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3155
Practice Address - Country:US
Practice Address - Phone:931-427-6969
Practice Address - Fax:931-427-6967
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000095893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094697Medicaid
AL06702OtherBCBS OF AL
AL891001650Medicaid
AL06702OtherBCBS OF AL
TNS47554Medicare UPIN