Provider Demographics
NPI:1336560184
Name:FERGUSON, REBECCA LYNNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNNE
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 OCALE WAY N
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4622
Mailing Address - Country:US
Mailing Address - Phone:352-553-4075
Mailing Address - Fax:888-770-3208
Practice Address - Street 1:305 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4605
Practice Address - Country:US
Practice Address - Phone:352-344-4791
Practice Address - Fax:352-344-3822
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-20
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9168930363LF0000X
FLARNP9168930363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010828400Medicaid
FLAPRN9168930OtherFLORIDA MEDICAL LICENSE