Provider Demographics
NPI:1487642963
Name:SHOENFELT, REBA E (ARNP)
Entity Type:Individual
Prefix:
First Name:REBA
Middle Name:E
Last Name:SHOENFELT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1019
Mailing Address - Country:US
Mailing Address - Phone:727-214-7079
Mailing Address - Fax:954-245-3143
Practice Address - Street 1:7945 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1019
Practice Address - Country:US
Practice Address - Phone:727-214-7079
Practice Address - Fax:954-245-3143
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3027792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP52383Medicare UPIN
FLY0704YMedicare ID - Type Unspecified