Provider Demographics
NPI:1982870705
Name:FINKLEA, REBECCA RICO (LM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RICO
Last Name:FINKLEA
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 GLORIA AVE
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2801
Mailing Address - Country:US
Mailing Address - Phone:813-451-4093
Mailing Address - Fax:813-425-0443
Practice Address - Street 1:3102 GLORIA AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2801
Practice Address - Country:US
Practice Address - Phone:813-451-4093
Practice Address - Fax:813-425-0443
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW144176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340268100Medicaid