Provider Demographics
NPI:1326062043
Name:HATFIELD, RACHAEL A (CRNA)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:A
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 KIWI CT
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4723
Mailing Address - Country:US
Mailing Address - Phone:321-773-6702
Mailing Address - Fax:321-434-1656
Practice Address - Street 1:748 KIWI CT
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4723
Practice Address - Country:US
Practice Address - Phone:321-773-6702
Practice Address - Fax:321-434-1656
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV026785367500000X
FLARNP172122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002548Medicaid
FLG0628OtherBCBSFL
FLG0628OtherBCBSFL
WV3810002548Medicaid