Provider Demographics
NPI:1457623407
Name:MCALLISTER, REBECCA DENISE (ARNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENISE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:ATTN: CREDENTIAL DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:727-216-1141
Mailing Address - Fax:727-796-6459
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:STE 200
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-216-1141
Practice Address - Fax:727-796-6159
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1740292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111105900Medicaid