Provider Demographics
NPI:1306196126
Name:CRAIN, JIMMIE RHEA (RRT)
Entity Type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:RHEA
Last Name:CRAIN
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N SHANNON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2312
Mailing Address - Country:US
Mailing Address - Phone:850-688-3243
Mailing Address - Fax:
Practice Address - Street 1:3492 MARTIN HURST RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1702
Practice Address - Country:US
Practice Address - Phone:850-701-3920
Practice Address - Fax:850-701-3924
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6684227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006606400Medicaid