Healthcare Provider Details

I. General information

NPI: 1316306244
Provider Name (Legal Business Name): REBEKAH STEVENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2016
Last Update Date: 02/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 SW 37TH AVE STE 502
MIAMI FL
33133-2744
US

IV. Provider business mailing address

2645 SW 37TH AVE STE 502
MIAMI FL
33133-2744
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-8134
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: