Provider Demographics
NPI:1174569693
Name:FRALICKER, DEBORAH (DC)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:FRALICKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 CESERY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5605
Mailing Address - Country:US
Mailing Address - Phone:904-745-1444
Mailing Address - Fax:
Practice Address - Street 1:12620 BEACH BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7131
Practice Address - Country:US
Practice Address - Phone:904-645-0777
Practice Address - Fax:904-645-3483
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 4435111N00000X
FLARNP770742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380447000Medicaid
FL380447000Medicaid