Provider Demographics
NPI:1902372816
Name:LEE SANG, RACHEL (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LEE SANG
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 1:4230 PABLO PROFESSIONAL CT STE 103
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-3223
Mailing Address - Country:US
Mailing Address - Phone:904-329-1942
Mailing Address - Fax:
Practice Address - Street 1:1706 N SEMORAN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3568
Practice Address - Country:US
Practice Address - Phone:321-804-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily