MEDICARE: REBECKA D EWBANK PA-C

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	363AM0700X	Medical Physician Assistant	PA9107947	FL
2	363A00000X	Physician Assistant	PA9107947	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	US791	OTHER	FL	MEDICARE HF
3	US792	OTHER	FL	MEDICARE HFPSI

Other Identifiers

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

General Provider Information

NPI Number	:	1629246681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECKA D EWBANK PA-C

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 401
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 N MANGOUSTINE AVE STE 100
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-1004
Country	:	US
Telephone Number	:	407-323-7821
Fax Number	:

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

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	04/18/2025

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Directions to “ REBECKA D EWBANK PA-C” Practice Location

Language	Start Address	Practice Location

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