Provider Demographics
NPI:1427232487
Name:MARSHA K. RAUCH, PHD, ARNP
Entity Type:Organization
Organization Name:MARSHA K. RAUCH, PHD, ARNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ARNP
Authorized Official - Phone:407-869-1450
Mailing Address - Street 1:1450 W LAKE BRANTLEY RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4766
Mailing Address - Country:US
Mailing Address - Phone:407-869-1450
Mailing Address - Fax:407-574-4625
Practice Address - Street 1:2000 PREVATT ST
Practice Address - Street 2:SUITE B3
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6149
Practice Address - Country:US
Practice Address - Phone:407-869-1450
Practice Address - Fax:407-574-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5442DMedicare PIN