Provider Demographics
NPI:1346919123
Name:O'DONNELL, REBECCA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:O'DONNELL
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 1:1217 SALERNO CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5565
Mailing Address - Country:US
Mailing Address - Phone:724-816-5454
Mailing Address - Fax:
Practice Address - Street 1:2100 OCOEE APOPKA RD STE 210
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9210
Practice Address - Country:US
Practice Address - Phone:407-609-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114990363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant