Provider Demographics
NPI:1225167406
Name:KUERBITZ, REBECCA ELLEN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELLEN
Last Name:KUERBITZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CENTRAL FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32816-8005
Mailing Address - Country:US
Mailing Address - Phone:407-823-2701
Mailing Address - Fax:407-823-2701
Practice Address - Street 1:4000 CENTRAL FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32816-8005
Practice Address - Country:US
Practice Address - Phone:407-823-2701
Practice Address - Fax:407-823-2701
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP04115Medicare UPIN
FLE3952ZMedicare ID - Type UnspecifiedMCARE IND