Provider Demographics
NPI:1801629100
Name:GREEN, EMILY REBEKAH (PA-C)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:REBEKAH
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:125 FLORIDA MEMORIAL PKWY STE 2500
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-9315
Mailing Address - Country:US
Mailing Address - Phone:386-409-6850
Mailing Address - Fax:
Practice Address - Street 1:125 FLORIDA MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-9311
Practice Address - Country:US
Practice Address - Phone:386-409-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9119030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant