MEDICARE: REBECCA ETTA ACPN-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP116817	TX
2	363LA2100X	Acute Care Nurse Practitioner	662521	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8F23642	OTHER	TX	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1952560054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ETTA ACPN-BC

Provider Business Mailing Address
First Line	:	2300 ROCKBROOK DR
Second Line	:	SUITE 100 C
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8181
Country	:	US
Telephone Number	:	972-459-6632
Fax Number	:	972-459-6626

Provider Business Practice Location Address
First Line	:	2300 ROCKBROOK DR
Second Line	:	SUITE 100 C
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8181
Country	:	US
Telephone Number	:	972-459-6632
Fax Number	:	972-459-6626

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	01/12/2026

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Directions to “ REBECCA ETTA ACPN-BC” Practice Location

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