Provider Demographics
NPI:1821033986
Name:HARRILAL, RAJESH (ARNP)
Entity Type:Individual
Prefix:MR
First Name:RAJESH
Middle Name:
Last Name:HARRILAL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 JFK DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6607
Mailing Address - Country:US
Mailing Address - Phone:561-434-0353
Mailing Address - Fax:561-357-0869
Practice Address - Street 1:5503 S CONGRESS AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6625
Practice Address - Country:US
Practice Address - Phone:561-434-0353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2116922363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ47663Medicare UPIN
FLU5081XMedicare PIN