Provider Demographics
NPI:1861038077
Name:POLLACK, REBECCA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:POLLACK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34970 DETROIT RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2653
Mailing Address - Country:US
Mailing Address - Phone:440-590-3013
Mailing Address - Fax:
Practice Address - Street 1:34970 DETROIT RD UNIT 106
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2653
Practice Address - Country:US
Practice Address - Phone:440-250-0822
Practice Address - Fax:440-250-0887
Is Sole Proprietor?:No
Enumeration Date:2019-11-22
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025828207P00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine