Provider Demographics
NPI:1982007449
Name:MEDLIN, REBECCA SUE (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA SUE
Middle Name:
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:GROSHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 LAKE BALDWIN LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6651
Mailing Address - Country:US
Mailing Address - Phone:407-898-1500
Mailing Address - Fax:407-898-3022
Practice Address - Street 1:930 LAKE BALDWIN LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6651
Practice Address - Country:US
Practice Address - Phone:407-898-1500
Practice Address - Fax:407-898-3022
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9317071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA2842Medicare PIN