Provider Demographics
NPI:1134420292
Name:CHERTMAN, RAQUEL F (PAC)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:F
Last Name:CHERTMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:CHERTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1321 NW 14TH STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-324-5481
Mailing Address - Fax:305-324-7852
Practice Address - Street 1:1321 NW 14TH STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-324-5481
Practice Address - Fax:305-324-7852
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9105102OtherPA LICENSE