PETRA DEBOLT (NPI# 1144570862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144570862 |
| Entity Type | Individual |
| Full Name | PETRA DEBOLT |
| Other Name | PETRA DUGAN |
| Credential | A.R.N.P. |
| Practice Address |
3511 Martin Luther King Blvd Fort Myers FL 33916-4651 |
| Mailing Address |
Po Box 2147 Fort Myers FL 33902-2147 |
| Practice Telephone | 2393434910 |
| Practice Fax Number | 2393434911 |
| Mailing Telephone | 2394241449 |
| Mailing Fax Number | 2394241421 |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2015-02-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
ARNP2944422 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 008624400 | 05 |
| Street Address |
3511 MARTIN LUTHER KING BLVD |
| City | FORT MYERS |
| State | FL |
| Zip Code | 33916-4651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366452039 | James H Belcher | Family Medicine | 3511 Martin Luther King Blvd, Fort Myers, FL 33916 | 2006-08-08 |
| 1528439767 | Linda Mondragon | Physician Assistant | 3511 Martin Luther King Blvd, Fort Myers, FL 33916-4651 | 2015-10-14 |
| 1932577111 | Valencia Hayes | Physician Assistant | 3511 Martin Luther King Blvd, Fort Myers, FL 33916-4651 | 2015-09-04 |
| 1811221096 | Magdala Guerrier | Nurse Practitioner | 3511 Martin Luther King Blvd, Fort Myers, FL 33916-4651 | 2009-09-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982251377 | Tamara Alvarez | Behavioral Analyst | 3717 Metro Pkey, Apt 3207, Fort Myers, FL 33916 | 2019-08-21 |
| 1457853798 | Grant Community Residential Home | Community Health Worker | 2252 Wright Street (a), Fort Myers, FL 33916 | 2018-03-02 |
| 1811345887 | Alexis Walker | Specialist/Technologist | 1407 Gardenia Avenue, Fort Myers, FL 33916 | 2016-05-31 |
| 1346698669 | Irving Radiology, Inc | Radiology | 4110 Center Pointe Dr Ste 210, Fort Myers, FL 33916 | 2016-05-26 |
| 1629452347 | Ashley Ann Alberts | Nurse Practitioner | 4315 Metro Parkway, Suite 150, Fort Myers, FL 33916 | 2015-07-13 |
| 1932442837 | Nicolas Alonzo Bolanos | Counselor | 4150 Ford Street Extension, Fort Myers, FL 33916 | 2013-03-29 |
| 1588936785 | Optum Infusion Services 204, Inc. | Home Health | 4220 Executive Circle, Suite 62, Fort Myers, FL 33916 | 2012-02-02 |
| 1700181047 | Michele Lintz | Case Manager/Care Coordinator | 1280 Maravilla Lane, Ft Myers, FL 33916 | 2011-01-18 |
| 1821399114 | Dollar Rx Pharmacy | Pharmacy | 2950 Winkler Ave # 701, Fort Myers, FL 33916 | 2010-11-03 |
| 1942494687 | Benjamin M. Lowe | Pharmacist | 3033 Winkler Ave Ext, Fort Myers, FL 33916 | 2007-09-05 |
| Find all providers in zip 33916 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384154 | Melissa Connors | Nurse Practitioner | 15609 Fiddlesticks Blvd, Fort Myers, FL 33912-3902 | 2020-10-18 |
| 1982202412 | Amanda Shively | Nurse Practitioner | 7951 Reflection Cove Dr Apt 102, Fort Myers, FL 33907-6560 | 2020-10-16 |
| 1205433828 | Kenneth Midoneck | Nurse Practitioner | 4445 Kings Barn Ct Unit 305, Fort Myers, FL 33916-8031 | 2020-10-06 |
| 1881218246 | Miraleen Patel | Nurse Practitioner | 5710 Trailwinds Dr Apt 524, Fort Myers, FL 33907-8338 | 2020-06-02 |
| 1194350348 | Zuleima Lozada | Nurse Practitioner | 13691 Metro Pkwy Ste 110a, Fort Myers, FL 33912-4348 | 2020-03-09 |
| 1962034686 | Kathleen A Shelton | Nurse Practitioner | 9371 Cypress Lake Dr Ste 16, Fort Myers, FL 33919-4945 | 2020-02-11 |
| 1275173155 | Optimal Healing Healthcare Services, LLC | Nurse Practitioner | 10143 Chesapeake Bay Dr, Fort Myers, FL 33913-9184 | 2020-01-08 |
| 1033760731 | Jaclyn Mason | Nurse Practitioner | 18431 Hawthorne Rd, Fort Myers, FL 33967-3276 | 2019-09-24 |
| 1245894419 | Sonya Brielle Hayhurst | Nurse Practitioner | 16026 Via Solera Cir Apt 102, Fort Myers, FL 33908-7706 | 2019-04-23 |
| 1083175871 | Jackelin Smith | Nurse Practitioner | 10685 Essex Square Blvd, Fort Myers, FL 33913-2612 | 2019-03-26 |
| Find all providers in FORT MYERS | ||||
| City | FORT MYERS |
| Zip Code | 33916 |
Please comment or provide details below to improve the information on PETRA DEBOLT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.