Provider Demographics
NPI:1972150050
Name:AMOS, REBECCA ROSE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:AMOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 PARKERS LANDING DR APT 331
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5838
Mailing Address - Country:US
Mailing Address - Phone:407-666-0686
Mailing Address - Fax:
Practice Address - Street 1:10631 PARKERS LANDING DR APT 331
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5838
Practice Address - Country:US
Practice Address - Phone:407-666-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP11002781363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care