Provider Demographics
NPI:1871856146
Name:ALBOHER, RAEANN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:RAEANN
Middle Name:
Last Name:ALBOHER
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 1:1340 S 18TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4799
Mailing Address - Country:US
Mailing Address - Phone:904-261-7707
Mailing Address - Fax:
Practice Address - Street 1:1250 S 18TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1902
Practice Address - Country:US
Practice Address - Phone:904-261-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9192645363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics