Healthcare Provider Details

I. General information

NPI: 1962485474
Provider Name (Legal Business Name): REBECCA JOAN HALL FNP-BC, APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA JOAN BERTSCH

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 SORRENTO RD SUITE B
PENSACOLA FL
32507-8762
US

IV. Provider business mailing address

8879 FOXTAIL LOOP
PENSACOLA FL
32526-3236
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-5686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9375314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: