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

Last updated

Jun 2, 2023By the provider in NPPES

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alw Enterprises, PA

  dba NAB Life Health

  • 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.