Rebecca Lynn Sulack, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11008673 Issued in FL

Practice address

1001 College Blvd W Ste B1
Niceville, FL 32578-1049

Phone

(850) 252-4303

NPI assigned

Jul 9, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Alw Enterprises, PA

  • Primary Care Clinic/Center
  • Niceville, FL
  • NPI 1548820798
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1669090296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 COLLEGE BLVD W STE B1",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781049",
            "telephone_number": "850-252-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 COLLEGE BLVD W STE B1",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325781049",
            "telephone_number": "850-252-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULACK",
        "first_name": "REBECCA",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9315777",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11008673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Anna Strickland
• Dalton Striedel
• Casi B Stubbs, DMD
• Cheryl A Stubbs, CCC SLP
• Subsecondllc
• Sure Vision Eye Care LLC
• Patti Sue Swenson-Abraham, LCSW
• Roxanne Szymanski, RBT
• Alex Szymborski, DMD
• Nigist Tadesse, DDS

• Family Nurse Practitioner in Niceville, FL
• Providers in Niceville, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.