MEDICARE: REBECCA LEE CPNP-PC

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
1	163WP0200X	Pediatric Registered Nurse	RN9410116	FL
2	163WP0218X	Pediatric Oncology Registered Nurse	RN9410116	FL
3	363LP0200X	Pediatric Nurse Practitioner	APRN11029330	FL
4	163W00000X	Registered Nurse	RN9410116	FL

General Provider Information

NPI Number	:	1376213215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LEE CPNP-PC

Provider Business Mailing Address
First Line	:	4196 W US HIGHWAY 90 STE 105
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8834
Country	:	US
Telephone Number	:	386-243-8474
Fax Number	:	386-438-5945

Provider Business Practice Location Address
First Line	:	4196 W US HIGHWAY 90 STE 105
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8834
Country	:	US
Telephone Number	:	386-243-8474
Fax Number	:	386-438-5945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	04/05/2024

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