Provider Demographics
NPI:1952081192
Name:WITRUKE, REBECCA ASHLEY (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ASHLEY
Last Name:WITRUKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:WITRUKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:2200 GLADES RD STE 305
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7348
Mailing Address - Country:US
Mailing Address - Phone:561-325-7686
Mailing Address - Fax:
Practice Address - Street 1:2200 GLADES RD STE 305
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7348
Practice Address - Country:US
Practice Address - Phone:561-325-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026920363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner