1639488141 NPI number — JESSICA LYNNE RACHBIND PA-C

Table of content: JESSICA LYNNE RACHBIND PA-C (NPI 1639488141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639488141 NPI number — JESSICA LYNNE RACHBIND PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RACHBIND
Provider First Name:
JESSICA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUMAS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639488141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10970 NW 17TH PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-536-4597
Provider Business Mailing Address Fax Number:
561-852-7611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8190 ROYAL PALM BLVD, STE 100
Provider Second Line Business Practice Location Address:
HOLY CROSS MEDICAL GROUP EAST CORAL SPRINGS
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-344-2288
Provider Business Practice Location Address Fax Number:
954-344-8443
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA9105683 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA9105683 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110299400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com