Provider Demographics
NPI:1083139539
Name:CHICCO, REBECCA (AP, DOM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CHICCO
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 GREEN WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4113
Mailing Address - Country:US
Mailing Address - Phone:727-504-0220
Mailing Address - Fax:
Practice Address - Street 1:475 CENTRAL AVE STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3859
Practice Address - Country:US
Practice Address - Phone:727-504-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist