1477213916 NPI number — RAASHIDA B PORTIER FNP

Table of content: RAASHIDA B PORTIER FNP (NPI 1477213916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477213916 NPI number — RAASHIDA B PORTIER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORTIER
Provider First Name:
RAASHIDA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477213916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1776 WOODSTEAD CT STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-1480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-724-3050
Provider Business Mailing Address Fax Number:
512-628-3314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7201 N UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-724-3050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/25/2021

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: 363LF0000X , with the licence number:  11017176 , 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)