Provider Demographics
NPI:1861072472
Name:COOKSEY, REBECCA J (NP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:COOKSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6021 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-3312
Mailing Address - Country:US
Mailing Address - Phone:850-724-4064
Mailing Address - Fax:850-724-4495
Practice Address - Street 1:6021 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535-3312
Practice Address - Country:US
Practice Address - Phone:850-724-4064
Practice Address - Fax:850-724-4495
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily