Provider Demographics
NPI:1396241253
Name:VAN SOMEREN, REBEKAH ANN (NP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:VAN SOMEREN
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 1:401 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4255
Mailing Address - Country:US
Mailing Address - Phone:872-231-3074
Mailing Address - Fax:312-635-0050
Practice Address - Street 1:4251 STACK BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8526
Practice Address - Country:US
Practice Address - Phone:321-953-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-31
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022876363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology