Basic Information
| Provider Information | |||||||||
| NPI: | 1194274712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGOROFF | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.R.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 8TH AVE W STE 101 | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342214737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9418454963 | ||||||||
| Practice Location | |||||||||
| Address1: | 579 S INDIANA AVE STE A | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342233751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414601341 | ||||||||
| FaxNumber: | 9414601345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2016 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP016519 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | APRN11011583 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.