Provider Demographics
NPI:1437124914
Name:PROSTKO, REBECCA A (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:PROSTKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 SW MARTIN DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2816
Mailing Address - Country:US
Mailing Address - Phone:772-223-6410
Mailing Address - Fax:772-223-0092
Practice Address - Street 1:938 SW MARTIN DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2816
Practice Address - Country:US
Practice Address - Phone:772-223-6410
Practice Address - Fax:772-223-0092
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22876Medicare UPIN
FL08394Medicare ID - Type Unspecified