Provider Demographics
NPI:1043586662
Name:SALERNO, RACHEL ELLEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELLEN
Last Name:SALERNO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:ELLEN
Other - Last Name:DYKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 N CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-2709
Mailing Address - Country:US
Mailing Address - Phone:386-254-4000
Mailing Address - Fax:386-226-5477
Practice Address - Street 1:1185 DUNLAWTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2905
Practice Address - Country:US
Practice Address - Phone:386-425-5477
Practice Address - Fax:386-425-5580
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9298152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGC110ZMedicare PIN