Provider Demographics
NPI:1023360435
Name:REZA, REBECCA K (ARNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:K
Last Name:REZA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:K
Other - Last Name:HUFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4348 SOUTHPOINT BLVD
Practice Address - Street 2:STE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0986
Practice Address - Country:US
Practice Address - Phone:904-281-1915
Practice Address - Fax:904-281-1119
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9360495163W00000X
MARN2281191163W00000X
FLARNP9360495363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health