Provider Demographics
NPI:1285479972
Name:FLEETWOOD, REBECCA A (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 PELICAN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6547
Mailing Address - Country:US
Mailing Address - Phone:864-643-8658
Mailing Address - Fax:
Practice Address - Street 1:4931 PELICAN BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6547
Practice Address - Country:US
Practice Address - Phone:864-643-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9657936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse