Provider Demographics
NPI:1477319424
Name:HILLS, RAQUEL DAPHNE
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:DAPHNE
Last Name:HILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90382
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-0382
Mailing Address - Country:US
Mailing Address - Phone:863-286-5408
Mailing Address - Fax:
Practice Address - Street 1:1430 S COMBEE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-7102
Practice Address - Country:US
Practice Address - Phone:863-286-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL0027644332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies