Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP9360495 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9360495 | FL |
NPI | 1023360435 |
---|---|
Provider Name | Ms. Rebecca K Reza |
First Address | Troy, MI 48099-1239 |
Second Address | Jacksonville, FL 32216-0986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 09/02/2022 |