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NPI Code Detail

MEDICARE: REBECCA CARVER FAGAN APRN

MEDICARE: REBECCA CARVER FAGAN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN11010912FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124619846
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA CARVER FAGAN APRN
Provider Business Mailing Address
First Line : 250 HARRISON ST
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-5094
Country : US
Telephone Number : 321-268-6868
Fax Number : 321-267-2713
Provider Business Practice Location Address
First Line : 250 HARRISON ST
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-5094
Country : US
Telephone Number : 321-268-6868
Fax Number : 321-267-2713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2021
Last Update Date : 07/02/2024

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Directions to “ REBECCA CARVER FAGAN APRN” Practice Location

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