1306819420 NPI number — DEBBIE LANDIS-NUSSBAUM ARNP CNM

Table of content: DEBBIE LANDIS-NUSSBAUM ARNP CNM (NPI 1306819420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306819420 NPI number — DEBBIE LANDIS-NUSSBAUM ARNP CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDIS-NUSSBAUM
Provider First Name:
DEBBIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANDIS
Provider Other First Name:
DEBBIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306819420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25317
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33622-5317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-286-0033
Provider Business Mailing Address Fax Number:
813-282-1806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 CORBETT ST
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
BELLEAIR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756-7309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-462-2229
Provider Business Practice Location Address Fax Number:
727-447-5610
Provider Enumeration Date:
02/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APRN1939462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: ARNP1939462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215135090 . This is a "GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 251910100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251910101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".