Provider Demographics
NPI:1356959324
Name:PROFFITT, REBECCA DAWN (NP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DAWN
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 ANN WAY
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-6818
Mailing Address - Country:US
Mailing Address - Phone:304-419-0829
Mailing Address - Fax:
Practice Address - Street 1:5055 BABCOCK ST NE STE 2
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4673
Practice Address - Country:US
Practice Address - Phone:321-724-1200
Practice Address - Fax:321-951-0675
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily