Provider Demographics
NPI:1184287278
Name:METAUTEN, RAISA (APRN)
Entity type:Individual
Prefix:
First Name:RAISA
Middle Name:
Last Name:METAUTEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18210 MEDITERRANEAN BLVD APT 2006
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5740
Mailing Address - Country:US
Mailing Address - Phone:786-428-4442
Mailing Address - Fax:
Practice Address - Street 1:16800 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5501
Practice Address - Country:US
Practice Address - Phone:305-318-6795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11001592363LF0000X
FLAPRN11001592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily