Basic Information
| Provider Information | |||||||||
| NPI: | 1932134673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAY | ||||||||
| FirstName: | DEBORA | ||||||||
| MiddleName: | COULAPIDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1570 ISLAND LN | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320037453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641204 | ||||||||
| FaxNumber: | 9042641227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1570 ISLAND LN | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320037453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641204 | ||||||||
| FaxNumber: | 9042641227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 05/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | CA282535 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | ARNP9314409 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.