Provider Demographics
NPI:1881066272
Name:RACOVITA, MARIANA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:RACOVITA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 PARK BEND DR STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5674
Mailing Address - Country:US
Mailing Address - Phone:512-697-7090
Mailing Address - Fax:512-697-7097
Practice Address - Street 1:2217 PARK BEND DR STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5674
Practice Address - Country:US
Practice Address - Phone:512-697-7090
Practice Address - Fax:512-697-7097
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109071363A00000X
IL085008615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant