Healthcare Provider Details

I. General information

NPI: 1588200653
Provider Name (Legal Business Name): REBEKAH ANNE HUGHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WINDERMERE WAY
ST AUGUSTINE FL
32095-7558
US

IV. Provider business mailing address

88 WINDERMERE WAY
ST AUGUSTINE FL
32095-7558
US

V. Phone/Fax

Practice location:
  • Phone: 863-255-5732
  • Fax:
Mailing address:
  • Phone: 863-255-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11015596
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236386
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: