Individual
SOMMER NICOLE RUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1401
(321) 434-1667
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1401
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9118003
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120020200
—
FL
Enumeration date
10/04/2023
Last updated
10/26/2023
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