Provider Demographics
NPI:1376085084
Name:ALI-MUHAMMAD, RAVEN SHAMANIEK (ARNP)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:SHAMANIEK
Last Name:ALI-MUHAMMAD
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-778-0444
Mailing Address - Fax:813-355-5017
Practice Address - Street 1:38135 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7505
Practice Address - Country:US
Practice Address - Phone:813-778-0444
Practice Address - Fax:813-355-5017
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9326292363LF0000X
FLAPRN9326292363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily