1881106813 NPI number — RACHAEL EILEEN PELAEZ ARNP

Table of content: RACHAEL EILEEN PELAEZ ARNP (NPI 1881106813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881106813 NPI number — RACHAEL EILEEN PELAEZ ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELAEZ
Provider First Name:
RACHAEL
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURKE
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881106813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 5TH ST S STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-4804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-767-4170
Provider Business Mailing Address Fax Number:
727-767-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 5TH ST S STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33701-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-767-4170
Provider Business Practice Location Address Fax Number:
727-767-4346
Provider Enumeration Date:
10/31/2017

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: 363LP0200X , with the licence number:  ARNP9220987 , 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: ARNP9220987 . This is a "STATE NP LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".