Provider Demographics
NPI:1184803223
Name:RAKOCY, ROSE MARIE THERESA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ROSE MARIE
Middle Name:THERESA
Last Name:RAKOCY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:ROSE MARIE
Other - Middle Name:THERESA
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:221 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5066
Mailing Address - Country:US
Mailing Address - Phone:850-833-9240
Mailing Address - Fax:
Practice Address - Street 1:1350 JOE MARTIN CIR
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1317
Practice Address - Country:US
Practice Address - Phone:850-833-4339
Practice Address - Fax:850-833-4357
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1181861164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse