=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861072472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA J COOKSEY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2021
-----------------------------------------------------
Last Update Date | 09/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6021 INDUSTRIAL BLVD
-----------------------------------------------------
City | CENTURY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32535-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-724-4064
-----------------------------------------------------
Fax | 850-724-4495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6021 INDUSTRIAL BLVD
-----------------------------------------------------
City | CENTURY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32535-3312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-724-4064
-----------------------------------------------------
Fax | 850-724-4495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11010810
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------