Provider Demographics
NPI:1609081595
Name:RAIA, LUCILLE VERONICA (ADVANCED NURSE PRACI)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:VERONICA
Last Name:RAIA
Suffix:
Gender:F
Credentials:ADVANCED NURSE PRACI
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Mailing Address - Street 1:2152 PORTOFINO PL
Mailing Address - Street 2:CONDO # 292
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-7755
Mailing Address - Country:US
Mailing Address - Phone:727-692-4885
Mailing Address - Fax:508-437-8523
Practice Address - Street 1:101 ACCESS RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5211
Practice Address - Country:US
Practice Address - Phone:781-551-8002
Practice Address - Fax:781-551-8004
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2017-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAARNP152540363L00000X
FLARNP9211153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner