Provider Demographics
NPI:1225137235
Name:MURRAY, INGRID RAFAELA (PA)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:RAFAELA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:INGRID
Other - Middle Name:RAFAELA
Other - Last Name:PICHARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14716 CAPOTE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7306
Mailing Address - Country:US
Mailing Address - Phone:407-256-2870
Mailing Address - Fax:407-518-0094
Practice Address - Street 1:1050 W CARROLL ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1268
Practice Address - Country:US
Practice Address - Phone:407-518-0078
Practice Address - Fax:407-518-0094
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101723363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical