Provider Demographics
NPI:1497726319
Name:SMITH, RACHEL EFFOLIA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:EFFOLIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 EMERSON DR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7897
Mailing Address - Country:US
Mailing Address - Phone:321-952-4914
Mailing Address - Fax:321-727-8740
Practice Address - Street 1:VA OUTPATIENT CLINIC
Practice Address - Street 2:2900 VETERANS WAY
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:321-637-3507
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3137612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS84150Medicare UPIN