Provider Demographics
NPI:1891085114
Name:RICCHI, REBECCA MAHAN (NURSE PRACTITTIONER)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MAHAN
Last Name:RICCHI
Suffix:
Gender:F
Credentials:NURSE PRACTITTIONER
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:MAHAN
Other - Last Name:BARTHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:4161 CARMICHAEL AVENUE SUITE 150
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207
Mailing Address - Country:US
Mailing Address - Phone:904-829-8954
Mailing Address - Fax:
Practice Address - Street 1:4161 CARMICHAEL AVENUE STE 150
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4301
Practice Address - Country:US
Practice Address - Phone:904-829-8954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1228792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health