Provider Demographics
NPI:1700467339
Name:DAGGETT, REBECCA (APRN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:DAGGETT
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 1:5880 49TH ST N
Mailing Address - Street 2:STE 104
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2142
Mailing Address - Country:US
Mailing Address - Phone:727-528-6100
Mailing Address - Fax:727-528-7895
Practice Address - Street 1:5880 49TH ST N STE 104
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2142
Practice Address - Country:US
Practice Address - Phone:727-528-6100
Practice Address - Fax:727-528-7895
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner