Provider Demographics
NPI:1013482371
Name:ISSAC, REBA ELSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBA
Middle Name:ELSA
Last Name:ISSAC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21141 MIDDLEBELT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5516
Mailing Address - Country:US
Mailing Address - Phone:248-477-7022
Mailing Address - Fax:
Practice Address - Street 1:21141 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5516
Practice Address - Country:US
Practice Address - Phone:248-477-7022
Practice Address - Fax:248-477-9370
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily