Provider Demographics
NPI:1730434226
Name:PIERCE, REBEKAH ANN (PA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2250
Mailing Address - Fax:850-416-2536
Practice Address - Street 1:5153 N 9TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-2250
Practice Address - Fax:850-416-2536
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant