Provider Demographics
NPI:1649039553
Name:DOCTOR, REBECCA JEAN (BA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JEAN
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 W OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1234
Mailing Address - Country:US
Mailing Address - Phone:314-374-3732
Mailing Address - Fax:
Practice Address - Street 1:560 CHANNELSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-5618
Practice Address - Country:US
Practice Address - Phone:813-396-0075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program