Healthcare Provider Details

I. General information

NPI: 1720838121
Provider Name (Legal Business Name): REBEKAH LIEBERMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 SAINT JOHNS PKWY STE 109
SAINT JOHNS FL
32259-4593
US

IV. Provider business mailing address

2050 SAINT JOHNS PKWY STE 109
SAINT JOHNS FL
32259-4593
US

V. Phone/Fax

Practice location:
  • Phone: 954-815-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: