Provider Demographics
NPI:1912274861
Name:PITOTTI, REBECCA L (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:PITOTTI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:PENHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1140 ALMOND TREE LN
Mailing Address - Street 2:STE 306
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3233
Mailing Address - Country:US
Mailing Address - Phone:702-657-3873
Mailing Address - Fax:702-636-0787
Practice Address - Street 1:7616 CULEBRA RD
Practice Address - Street 2:STE. 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1476
Practice Address - Country:US
Practice Address - Phone:210-509-2603
Practice Address - Fax:210-334-2861
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297797YKQQMedicare PIN