Provider Demographics
NPI:1487900460
Name:ABBOTT, RACHAEL I (RN)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:I
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 301 BLVD E
Mailing Address - Street 2:LOT E-13
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-3585
Mailing Address - Country:US
Mailing Address - Phone:321-505-3835
Mailing Address - Fax:
Practice Address - Street 1:624 301 BLVD E
Practice Address - Street 2:LOT E-13
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-3585
Practice Address - Country:US
Practice Address - Phone:321-505-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9250695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse