Provider Demographics
NPI:1033803044
Name:KOCHANOWICZ, REBECCA (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOCHANOWICZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ALEXANDRIA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8298
Mailing Address - Country:US
Mailing Address - Phone:407-359-7997
Mailing Address - Fax:407-359-6662
Practice Address - Street 1:100 ALEXANDRIA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8298
Practice Address - Country:US
Practice Address - Phone:407-359-7997
Practice Address - Fax:407-359-6662
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118754200Medicaid