Provider Demographics
NPI:1679290225
Name:PICKENS, RACHEL
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5121 LEVANA ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2599
Mailing Address - Country:US
Mailing Address - Phone:660-342-7779
Mailing Address - Fax:
Practice Address - Street 1:5899 WHITFIELD AVE STE 203
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6153
Practice Address - Country:US
Practice Address - Phone:660-342-7779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-9839-451956374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician