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General NPI Number Information
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NPI Number | 1356959324
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Entity Type | Individual
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Provider Name | REBECCA DAWN PROFFITT NP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 5055 BABCOCK ST NE STE 2
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City | PALM BAY
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State | FL
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Zip | 32905-4673
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Country | US
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Telephone | 321-724-1200
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Fax | 321-951-0675
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Provider Business Mailing Address
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Address Line | 745 ANN WAY
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City | COCOA
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State | FL
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Zip | 32926-6818
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Country | US
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Telephone | 304-419-0829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11007623
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License Number State | FL
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