Provider Demographics
NPI:1942470612
Name:WOMACK, REBECCA LISA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LISA
Last Name:WOMACK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 W EAU GALLIE BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8961
Mailing Address - Country:US
Mailing Address - Phone:321-752-5544
Mailing Address - Fax:321-752-5957
Practice Address - Street 1:2551 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8961
Practice Address - Country:US
Practice Address - Phone:321-752-5544
Practice Address - Fax:321-752-5957
Is Sole Proprietor?:No
Enumeration Date:2008-03-09
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2951422363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health