Provider Demographics
NPI:1942478433
Name:SMITH, RACHEL CREATH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:CREATH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:CREATH
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 116658
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6658
Mailing Address - Country:US
Mailing Address - Phone:615-574-1927
Mailing Address - Fax:615-217-7238
Practice Address - Street 1:636 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2668
Practice Address - Country:US
Practice Address - Phone:239-424-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1574363A00000X
TNTNPA1574363A00000X
FLPA9112211363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant