Provider Demographics
NPI:1992852198
Name:ENSLEY, REBECCA J (DO)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:ENSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7152 COCA SABAL LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4263
Mailing Address - Country:US
Mailing Address - Phone:239-939-9939
Mailing Address - Fax:239-931-5060
Practice Address - Street 1:7152 COCA SABAL LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4263
Practice Address - Country:US
Practice Address - Phone:239-939-9939
Practice Address - Fax:239-931-5060
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
CA20A9934207R00000X, 207RG0100X
FLOS15827207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No171000000XOther Service ProvidersMilitary Health Care Provider
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine