=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992697270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA FITZGERALD APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2025
-----------------------------------------------------
Last Update Date | 07/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3498 NW FEDERAL HWY
-----------------------------------------------------
City | JENSEN BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34957-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-261-9636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 TIMBERWALK TRL
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-5574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-319-2922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 11037583
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------