Provider Demographics
NPI:1376213215
Name:LEE, REBECCA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 W US HIGHWAY 90 STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8834
Mailing Address - Country:US
Mailing Address - Phone:386-243-8474
Mailing Address - Fax:386-438-5945
Practice Address - Street 1:4196 W US HIGHWAY 90 STE 105
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8834
Practice Address - Country:US
Practice Address - Phone:386-243-8474
Practice Address - Fax:386-438-5945
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9410116163WP0200X, 163WP0218X, 163W00000X
FLAPRN11029330363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
No163W00000XNursing Service ProvidersRegistered Nurse