Provider Demographics
NPI:1730237900
Name:ROSS, DEBORAH JANE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JANE
Last Name:ROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 NE WAX MYRTLE WAY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4794
Mailing Address - Country:US
Mailing Address - Phone:772-334-4417
Mailing Address - Fax:772-334-4417
Practice Address - Street 1:663 NE WAX MYRTLE WAY
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4794
Practice Address - Country:US
Practice Address - Phone:772-334-4417
Practice Address - Fax:772-334-4417
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator