Provider Demographics
NPI:1558032045
Name:ELLIOTT, RACHEL ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:ELLIOTT
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 1:761 CHEVY LN
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-7249
Mailing Address - Country:US
Mailing Address - Phone:850-567-9128
Mailing Address - Fax:
Practice Address - Street 1:761 CHEVY LN
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-7249
Practice Address - Country:US
Practice Address - Phone:850-567-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11015569363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner