Provider Demographics
NPI:1285122978
Name:NOURSE, REBECCA ALYN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ALYN
Last Name:NOURSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 SE 135TH ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-2442
Mailing Address - Country:US
Mailing Address - Phone:352-817-1131
Mailing Address - Fax:
Practice Address - Street 1:10252 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-6819
Practice Address - Country:US
Practice Address - Phone:352-233-7465
Practice Address - Fax:352-547-5787
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician