Provider Demographics
NPI:1871914275
Name:RAPHAEL, JUDENIE (AUD)
Entity type:Individual
Prefix:
First Name:JUDENIE
Middle Name:
Last Name:RAPHAEL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 N LAURA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4912
Mailing Address - Country:US
Mailing Address - Phone:904-344-3403
Mailing Address - Fax:904-355-4149
Practice Address - Street 1:1128 N LAURA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4912
Practice Address - Country:US
Practice Address - Phone:904-344-3403
Practice Address - Fax:904-355-4149
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9502265163W00000X, 163WH0200X
376J00000X
FLAY1834231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010514600Medicaid
GA003154616AMedicaid
FLHS669XMedicare PIN
GA003154616AMedicaid