Provider Demographics
NPI:1720046006
Name:FREEMAN, REBECCA AGNES (AP)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:AGNES
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9A MAGNOLIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5617
Mailing Address - Country:US
Mailing Address - Phone:850-243-1830
Mailing Address - Fax:
Practice Address - Street 1:1 11TH AVE STE A1
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1318
Practice Address - Country:US
Practice Address - Phone:850-651-0160
Practice Address - Fax:850-651-0160
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1539171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0759OtherBLUE CROSS BLUE SHIELD-AC
FLC1660OtherBLUE CROSSBLUE SHIELD-MAS