Provider Demographics
NPI:1629536982
Name:RASKE, DARREN R (RN)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:R
Last Name:RASKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13741 BEE TREE CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-1378
Mailing Address - Country:US
Mailing Address - Phone:727-409-8675
Mailing Address - Fax:
Practice Address - Street 1:13741 BEE TREE CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-1378
Practice Address - Country:US
Practice Address - Phone:727-409-8675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9356354163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9356354OtherFLORIDA RN LICENSE