Provider Demographics
NPI:1811584493
Name:LOUWSMA, RACHEL ANNE (PA)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANNE
Last Name:LOUWSMA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:317 NORTON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6044
Mailing Address - Country:US
Mailing Address - Phone:850-402-6215
Mailing Address - Fax:850-894-6768
Practice Address - Street 1:317 NORTON DR STE 102
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6044
Practice Address - Country:US
Practice Address - Phone:850-402-6215
Practice Address - Fax:850-894-6768
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113729363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115250000Medicaid