Healthcare Provider Details

I. General information

NPI: 1487642963
Provider Name (Legal Business Name): REBA E SHOENFELT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 1ST AVE S
ST PETERSBURG FL
33707-1019
US

IV. Provider business mailing address

7945 1ST AVE S
ST PETERSBURG FL
33707-1019
US

V. Phone/Fax

Practice location:
  • Phone: 727-214-7079
  • Fax: 954-245-3143
Mailing address:
  • Phone: 727-214-7079
  • Fax: 954-245-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3027792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: