Provider Demographics
NPI:1003572041
Name:HADDAD, REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HADDAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 FORREST VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5212
Mailing Address - Country:US
Mailing Address - Phone:412-841-3114
Mailing Address - Fax:
Practice Address - Street 1:128 RAYMOND HIRSCH PKWY
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8193
Practice Address - Country:US
Practice Address - Phone:715-672-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TN4919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4919OtherTN BOARD OF MEDICAL EXAMINERS
TNMH7058298OtherDEA