Provider Demographics
NPI:1134951189
Name:RENTZKE, EMMA ROSE (FNP)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:ROSE
Last Name:RENTZKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:EMMA
Other - Middle Name:ROSE
Other - Last Name:VAN CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3822 LANCOVE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4704
Mailing Address - Country:US
Mailing Address - Phone:772-332-9282
Mailing Address - Fax:
Practice Address - Street 1:3822 LANCOVE WAY
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4704
Practice Address - Country:US
Practice Address - Phone:772-332-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily