Provider Demographics
NPI:1972980274
Name:BOYNE, REBECCA LYNN (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:BOYNE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:LICHWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:4602 N. HABANA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-321-6589
Mailing Address - Fax:813-321-6590
Practice Address - Street 1:4602 N. HABANA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-321-6589
Practice Address - Fax:813-321-6590
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015026500Medicaid