Provider Demographics
NPI:1609645191
Name:RAIN, VICTORIA GLADDEN (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:GLADDEN
Last Name:RAIN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-6232
Mailing Address - Fax:855-975-0615
Practice Address - Street 1:73-5618 MAIAU ST STE A204
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2634
Practice Address - Country:US
Practice Address - Phone:808-329-1146
Practice Address - Fax:808-329-1120
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2024-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9118307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant