Provider Demographics
NPI:1699725341
Name:PICKETT, DEANA L (ARNP)
Entity type:Individual
Prefix:
First Name:DEANA
Middle Name:L
Last Name:PICKETT
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 1:316 GROVELAND ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4019
Mailing Address - Country:US
Mailing Address - Phone:407-896-9660
Mailing Address - Fax:407-896-9661
Practice Address - Street 1:316 GROVELAND ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4019
Practice Address - Country:US
Practice Address - Phone:407-896-9660
Practice Address - Fax:407-896-9661
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1427792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4443ZMedicare ID - Type Unspecified
FLP11944 0001Medicare UPIN