Provider Demographics
NPI:1346596707
Name:MAGWOOD, REBECCA HOPE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HOPE
Last Name:MAGWOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:HOPE
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1397 MEDICAL PARK BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3187
Mailing Address - Country:US
Mailing Address - Phone:561-784-0202
Mailing Address - Fax:561-641-7732
Practice Address - Street 1:1397 MEDICAL PARK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-784-0202
Practice Address - Fax:561-641-7732
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant