Provider Demographics
NPI: | 1538694328 |
---|---|
Name: | MARACIC, RACHELLE ELAINE (ARNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | RACHELLE |
Middle Name: | ELAINE |
Last Name: | MARACIC |
Suffix: | |
Gender: | F |
Credentials: | ARNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1515 SW ARCHER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | GAINESVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32608-1134 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-265-0111 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1515 SW ARCHER RD |
Practice Address - Street 2: | |
Practice Address - City: | GAINESVILLE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32608-1134 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-265-0111 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-04-29 |
Last Update Date: | 2017-07-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ARNP9277888 | 363LA2100X, 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 021439200 | Medicaid | |
FL | IZ442Z | Other | MEDICARE PTAN |