Individual provider Active NPI

Rebecca Roberts, P.A.-C

  • Physician Assistant
  • Cape Coral, FL
National Provider Identifier
1962560755
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9102541 Issued in FL
Practice address
1255 Viscaya Pkwy Ste 200
Cape Coral, FL 33990-3290
Phone
(239) 574-1988
Fax
(239) 574-1435
NPI assigned
Dec 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102541 FL Primary

Addresses

Primary practice location

1255 Viscaya Pkwy Ste 200
Cape Coral, FL 33990-3290

Mailing address

12730 New Brittany Blvd Ste 602
Fort Myers, FL 33907-4690
Phone (239) 275-5522

Other identifiers 1

IdentifierTypeStateIssuer
Y0F0GOtherFLFLORIDA BLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1962560755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12730 NEW BRITTANY BLVD STE 602",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339074690",
            "telephone_number": "239-275-5522",
            "fax_number": "239-275-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 VISCAYA PKWY STE 200",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339903290",
            "telephone_number": "239-574-1988",
            "fax_number": "239-574-1435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "REBECCA",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2020-10-13",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "Y0F0G",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Coral, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.