Provider Demographics
NPI:1386101798
Name:SICILIAN, DEBRA LEE (APRN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:LEE
Last Name:SICILIAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 CHAMBERLAIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4067
Mailing Address - Country:US
Mailing Address - Phone:239-246-8967
Mailing Address - Fax:
Practice Address - Street 1:2327 JEFFCOTT ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5211
Practice Address - Country:US
Practice Address - Phone:239-246-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE