Provider Demographics
NPI:1750370417
Name:PITT, RAQUEL F (PA-C MPAS)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:F
Last Name:PITT
Suffix:
Gender:F
Credentials:PA-C MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 MIZELL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4155
Mailing Address - Country:US
Mailing Address - Phone:407-646-7045
Mailing Address - Fax:407-646-7035
Practice Address - Street 1:1925 MIZELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4155
Practice Address - Country:US
Practice Address - Phone:407-646-7045
Practice Address - Fax:407-646-7035
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2912465-00Medicaid
FLE7381YMedicare ID - Type Unspecified
FL2912465-00Medicaid