Provider Demographics
NPI:1376278788
Name:SKINNER, REBECCA (APRN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 MOUNT PISGAH RD
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-9328
Mailing Address - Country:US
Mailing Address - Phone:863-581-6217
Mailing Address - Fax:
Practice Address - Street 1:601 E OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4574
Practice Address - Country:US
Practice Address - Phone:321-337-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily