Provider Demographics
NPI:1972961811
Name:PADAVICH (HENSLEY), REBECCA JO (RN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:PADAVICH (HENSLEY)
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 1:4222 RAMSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-6341
Mailing Address - Country:US
Mailing Address - Phone:307-421-4058
Mailing Address - Fax:
Practice Address - Street 1:3763 EVANS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9302
Practice Address - Country:US
Practice Address - Phone:239-275-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-06
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9387909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse