Provider Demographics
NPI:1538852934
Name:CHAMBLISS, REBECCA KAPLAN (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAPLAN
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 CERVANTES WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3326
Mailing Address - Country:US
Mailing Address - Phone:650-451-8853
Mailing Address - Fax:
Practice Address - Street 1:1183 CERVANTES WAY
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3326
Practice Address - Country:US
Practice Address - Phone:650-451-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner