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General NPI Number Information
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NPI Number | 1740845817
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Entity Type | Individual
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Provider Name | REBECCA J TAE PA
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Gender | Female
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Dates
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Enumeration Date | 05/04/2019
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 9332 STATE ROAD 54 STE 405
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City | TRINITY
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State | FL
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Zip | 34655-1810
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Country | US
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Telephone | 727-375-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 9332 STATE ROAD 54 STE 405
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City | TRINITY
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State | FL
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Zip | 34655-1810
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Country | US
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Telephone | 727-375-8264
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9117828
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License Number State | FL
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