Provider Demographics
NPI:1184797458
Name:AXLEY, DEBRA (ARNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:AXLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BAYOU BLVD STE 43
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1910
Mailing Address - Country:US
Mailing Address - Phone:850-477-3015
Mailing Address - Fax:850-477-3026
Practice Address - Street 1:4400 BAYOU BLVD STE 43
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1910
Practice Address - Country:US
Practice Address - Phone:850-477-3015
Practice Address - Fax:850-477-3026
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1012172363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00316280OtherRRB PTAN
FL306445000Medicaid
FLE2847ZMedicare PIN