Provider Demographics
NPI:1043586662
Name:HART, RACHEL ELLEN (NP-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELLEN
Last Name:HART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:ELLEN
Other - Last Name:DYKES AND SALERNO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:937 N SPRING GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2560
Mailing Address - Country:US
Mailing Address - Phone:386-736-1948
Mailing Address - Fax:386-734-4571
Practice Address - Street 1:937 N SPRING GARDEN AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2560
Practice Address - Country:US
Practice Address - Phone:386-736-1948
Practice Address - Fax:386-734-4571
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9298152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGC110ZMedicare PIN