Provider Demographics
NPI:1578911392
Name:NIGHTINGALE, REBECCA KIREN (PA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:KIREN
Last Name:NIGHTINGALE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:20280 MARKET ST
Mailing Address - Street 2:EASTERN SHORE RURAL HEALTH SYSTEM CORPORATE OFFICE
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-1331
Mailing Address - Country:US
Mailing Address - Phone:757-414-0400
Mailing Address - Fax:757-414-0569
Practice Address - Street 1:5219 LANKFORD HWY
Practice Address - Street 2:ATLANTIC COMMUNITY HEALTH CENTER
Practice Address - City:NEW CHURCH
Practice Address - State:VA
Practice Address - Zip Code:23415-3332
Practice Address - Country:US
Practice Address - Phone:757-824-5676
Practice Address - Fax:757-824-5872
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2016-06-28
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Provider Licenses
StateLicense IDTaxonomies
VA0110005380363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant