Provider Demographics
NPI:1164159778
Name:STUBBLEFIELD, REBECCA MONTEMAYOR (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MONTEMAYOR
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 WORTHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6635
Mailing Address - Country:US
Mailing Address - Phone:281-728-4237
Mailing Address - Fax:
Practice Address - Street 1:4955 WORTHINGTON CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6635
Practice Address - Country:US
Practice Address - Phone:281-728-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily