Provider Demographics
NPI:1720658800
Name:BELFORD, RACHAEL DENISE
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DENISE
Last Name:BELFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CLYDE MORRIS BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8187
Mailing Address - Country:US
Mailing Address - Phone:618-841-2919
Mailing Address - Fax:
Practice Address - Street 1:200 SANDS PARC BLVD APT 102
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-0038
Practice Address - Country:US
Practice Address - Phone:618-841-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013561363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05210911OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
FL11013561OtherADVANCED PRACTICE REGISTERED NURSE