Provider Demographics
NPI:1558827592
Name:LEVINE, REBECCA N (PA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:N
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 LAKELAND HILLS BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805
Mailing Address - Country:US
Mailing Address - Phone:863-687-1100
Mailing Address - Fax:
Practice Address - Street 1:110 LEGACY PARK WAY
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-1206
Practice Address - Country:US
Practice Address - Phone:205-719-1000
Practice Address - Fax:205-467-6963
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112012363A00000X
ALPA.2221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant