Healthcare Provider Details

I. General information

NPI: 1154528743
Provider Name (Legal Business Name): REBEKAH L. WHEATLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY NEMOURS CHILDRENS CLINIC, JACKSONVILLE
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

P.O. BOX 5720 PROVIDER ENROLLMENT DEPARTMENT
JACKSONVILLE FL
32247-5720
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3694
  • Fax: 904-697-3927
Mailing address:
  • Phone: 302-651-6718
  • Fax: 407-650-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number50184
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME110260
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME110260
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: