Provider Demographics
NPI:1174231427
Name:HAMATA, REBECCA CATHERINE LUCILLE (PA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CATHERINE LUCILLE
Last Name:HAMATA
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:
Practice Address - Street 1:2100 35TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3910
Practice Address - Country:US
Practice Address - Phone:970-475-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10004000A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant