Provider Demographics
NPI:1467789347
Name:RAYCHOK, DENISE LYNN (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:RAYCHOK
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE 17TH STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4191
Mailing Address - Country:US
Mailing Address - Phone:352-789-6008
Mailing Address - Fax:352-512-0510
Practice Address - Street 1:1800 SE 17TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4191
Practice Address - Country:US
Practice Address - Phone:352-789-6008
Practice Address - Fax:352-512-0510
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3207182363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG81738Medicare UPIN