Provider Demographics
NPI:1033783220
Name:GERETY, REBECCA (APRN (AGACNP-BC))
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GERETY
Suffix:
Gender:F
Credentials:APRN (AGACNP-BC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 PGA BLVD STE 450
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2841
Mailing Address - Country:US
Mailing Address - Phone:305-243-3564
Mailing Address - Fax:
Practice Address - Street 1:3401 PGA BLVD STE 450
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2841
Practice Address - Country:US
Practice Address - Phone:305-243-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021503363LA2200X, 363LG0600X
IN71011224A363LA2100X
FL11021503363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300051460Medicaid
INM32727011OtherMEDICARE PTAN