Provider Demographics
NPI:1467119925
Name:PECK, REBECCA KAY (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:PECK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 US HIGHWAY 98 S
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-8365
Mailing Address - Country:US
Mailing Address - Phone:863-899-1750
Mailing Address - Fax:
Practice Address - Street 1:1836 N CRYSTAL LAKE DR APT 78
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6587
Practice Address - Country:US
Practice Address - Phone:863-899-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016643363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily