Provider Demographics
NPI:1366840332
Name:LUTHER, RACHAEL (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:LUTHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15131 TAMIAMI TRAIL
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2711
Mailing Address - Country:US
Mailing Address - Phone:941-423-5056
Mailing Address - Fax:941-423-5018
Practice Address - Street 1:15131 TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2711
Practice Address - Country:US
Practice Address - Phone:941-423-5056
Practice Address - Fax:941-423-5018
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9213653363LF0000X
FLARNP9213653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1K111ZMedicare UPIN