Individual
DEBBIE MICHELLE SEVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
672 SW PRIMA VISTA BLVD STE 101, PORT ST LUCIE, FL 34983-1820
(772) 905-2555
(772) 336-8153
Mailing address
PO BOX 4189, DEERFIELD BEACH, FL 33442-4189
(954) 303-9582
(954) 303-9663
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
21454
PR
208D00000X
General Practice Physician
Primary
ACN1362
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114251500
—
FL
01
—
N9218
MEDICARE
FL
Enumeration date
04/11/2018
Last updated
11/01/2022
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