Provider Demographics
NPI:1760422331
Name:HERMANN, RACHEL BETH (APRN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BETH
Last Name:HERMANN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:727-849-8771
Mailing Address - Fax:727-849-4982
Practice Address - Street 1:6633 FOREST AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-849-8771
Practice Address - Fax:727-849-4982
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226676363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308034000Medicaid
FLY082ROtherBLUE CROSS BLUE SHIELD
P01501000Medicare PIN
FLY082RXMedicare PIN
Q53509Medicare UPIN
FLY082RZMedicare PIN
FL308034000Medicaid