Provider Demographics
NPI:1528823234
Name:MIRABELLI, DEBORAH (FNP-BC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MIRABELLI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SOUTHERN BREEZE LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5095
Mailing Address - Country:US
Mailing Address - Phone:407-832-9171
Mailing Address - Fax:
Practice Address - Street 1:107 SOUTHERN BREEZE LOOP
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-5095
Practice Address - Country:US
Practice Address - Phone:407-832-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP9513342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner