MEDICARE: RAVEN PATRICIA MICHELLE PRINCE CCMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1013875616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN PATRICIA MICHELLE PRINCE CCMA

Provider Business Mailing Address
First Line	:	2229 MANDRELL CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-2758
Country	:	US
Telephone Number	:	352-995-1562
Fax Number	:

Provider Business Practice Location Address
First Line	:	2229 MANDRELL CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-2758
Country	:	US
Telephone Number	:	352-995-1562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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