Provider Demographics
NPI:1366860736
Name:PLANT, REBECCA MEREDITH
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MEREDITH
Last Name:PLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MEREDITH
Other - Last Name:LUNCEFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:813-974-2201
Mailing Address - Fax:813-974-2812
Practice Address - Street 1:17 DAVIS BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3475
Practice Address - Country:US
Practice Address - Phone:813-259-8725
Practice Address - Fax:813-259-8792
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131808208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021181100Medicaid
FLEOWHZOtherBLUE CROSS BLUE SHIELD