Provider Demographics
NPI:1740083856
Name:BRACKEN, REBECCA ANDREA (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANDREA
Last Name:BRACKEN
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 AMADOR AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8074
Mailing Address - Country:US
Mailing Address - Phone:321-745-5451
Mailing Address - Fax:
Practice Address - Street 1:1408 AMADOR AVE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-8074
Practice Address - Country:US
Practice Address - Phone:321-745-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5242466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse