Provider Demographics
NPI:1881365476
Name:ALTAF, RABAIL (PA-C)
Entity type:Individual
Prefix:
First Name:RABAIL
Middle Name:
Last Name:ALTAF
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 1:109 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-7770
Mailing Address - Country:US
Mailing Address - Phone:912-000-0000
Mailing Address - Fax:
Practice Address - Street 1:ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-12-10
Deactivation Date:2021-10-15
Deactivation Code:
Reactivation Date:2021-11-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant