Provider Demographics
NPI:1962538371
Name:HALL, DEBRA SUE (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:HALL
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:S
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP, CNM
Mailing Address - Street 1:1560 KINGSLEY AVENUE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-264-1628
Mailing Address - Fax:904-264-8386
Practice Address - Street 1:1560 KINGSLEY AVENUE
Practice Address - Street 2:SUITE 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-264-1628
Practice Address - Fax:904-264-8386
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2053952207V00000X
FLARNP2053952367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology