Provider Demographics
NPI:1336643576
Name:DAILIDONIS, REBEKAH LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEE
Last Name:DAILIDONIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GORE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1051
Mailing Address - Country:US
Mailing Address - Phone:321-841-3050
Mailing Address - Fax:321-843-3570
Practice Address - Street 1:100 W GORE ST STE 600
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1051
Practice Address - Country:US
Practice Address - Phone:321-841-3050
Practice Address - Fax:321-843-3570
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308370363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025130600Medicaid