Petra Debolt, A.R.N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP2944422 Issued in FL

Practice address

3511 Martin Luther King Blvd
Fort Myers, FL 33916-4651

Phone

(239) 343-4910

Fax

(239) 343-4911

NPI assigned

Sep 11, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Petra Dugan Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Millennium Physician Group LLC

  • Family Medicine Physician
  • Fort Myers, FL
  • NPI 1811122880
  Medicare reassignment NPD
• Millennium Physician Group LLC

  • Family Medicine Physician
  • Brooksville, FL
  • NPI 1073131702
  NPD
• Ace Care Management Services LLC

  dba ACM Medical Transition Care

  • Clinic/Center
  • Tampa, FL
  • NPI 1659628295
  NPD (past)
• Lisa Bendetowicz, LCSW, LLC

  • Clinical Social Worker
  • Fort Myers, FL
  • NPI 1487200754
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423785600000",
    "number": "1144570862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-424-1449",
            "fax_number": "239-424-1421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3511 MARTIN LUTHER KING BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339164651",
            "telephone_number": "239-343-4910",
            "fax_number": "239-343-4911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBOLT",
        "first_name": "PETRA",
        "credential": "A.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-11",
        "last_updated": "2015-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP2944422",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008624400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PETRA",
            "last_name": "DUGAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristin Dearmond, DC
• Melanie Deaton, FNP
• Diane Angela Debboli-Flores, P.T.
• Mark Debenedictis
• Lori Marie Deblasi, DPM
• Kimberly Debow, APRN
• Debra Todd Black, D.O., P.a.
• Paul Samuel Decarlo Jr., D.D.S., P.A.
• Joaquina Decembre
• Matthew Daniel Dechene, RN

• Family Nurse Practitioner in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.