Provider Demographics
NPI:1477941623
Name:RAIMER, JUSTINA (PA)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:RAIMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 CARING WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5304
Mailing Address - Country:US
Mailing Address - Phone:941-629-3500
Mailing Address - Fax:941-629-3100
Practice Address - Street 1:1345 W BAY DR STE 101
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2276
Practice Address - Country:US
Practice Address - Phone:727-581-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant