Healthcare Provider Details

I. General information

NPI: 1891223814
Provider Name (Legal Business Name): REBECCA FLOYD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2017
Last Update Date: 06/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SILVER CROSS BLVD
NEW LENOX IL
60451-9509
US

IV. Provider business mailing address

4492 TIMBER RIDGE CT
JOLIET IL
60431-1707
US

V. Phone/Fax

Practice location:
  • Phone: 815-300-1100
  • Fax:
Mailing address:
  • Phone: 815-685-8298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: