Provider Demographics
NPI:1144703844
Name:LOWEN, REBECCA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:LOWEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-341-0074
Mailing Address - Fax:954-345-3474
Practice Address - Street 1:19615 STATE ROAD 7 STE 32
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4700
Practice Address - Country:US
Practice Address - Phone:561-477-7700
Practice Address - Fax:561-477-7707
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9111491363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101028900Medicaid