Healthcare Provider Details

I. General information

NPI: 1144471335
Provider Name (Legal Business Name): REBECCA LYNN GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN YEASTED M.D.

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PKWY
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

10140 CENTURION PKWY N FL PROVIDER
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax: 407-567-5924
Mailing address:
  • Phone: 904-697-5127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME113416
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME113416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: