Healthcare Provider Details

I. General information

NPI: 1063343218
Provider Name (Legal Business Name): REBEKAH KATHERINE STEVENSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 GAINER AVE
MILTON FL
32583-1751
US

IV. Provider business mailing address

4517 GAINER AVE
MILTON FL
32583-1751
US

V. Phone/Fax

Practice location:
  • Phone: 850-463-5673
  • Fax:
Mailing address:
  • Phone: 850-463-5673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11049205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: