Provider Demographics
NPI:1386931210
Name:BOMFORD, DEBORAH ANN (ARNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:BOMFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 WOODS WALK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2361
Mailing Address - Country:US
Mailing Address - Phone:561-707-5767
Mailing Address - Fax:
Practice Address - Street 1:22 CENTURY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3702
Practice Address - Country:US
Practice Address - Phone:877-714-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3006262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily