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General NPI Number Information
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NPI Number | 1376105544
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Entity Type | Individual
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Provider Name | MARY KATHRYN REBER APRN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 10/12/2019
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Provider Practice Location Address
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Address Line | 600 E GOVERNMENT ST
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City | PENSACOLA
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State | FL
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Zip | 32502-6136
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Country | US
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Telephone | 850-500-7527
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Fax | 850-855-4030
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Provider Business Mailing Address
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Address Line | 11945 SAN JOSE BLVD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1627
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Country | US
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Telephone | 904-396-1725
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Fax | 904-396-4893
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN9330896
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06192197
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License Number State | FL
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