MEDICARE: RAQUEL MICHELLE ODIETE PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11043237	FL

General Provider Information

NPI Number	:	1033088471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAQUEL MICHELLE ODIETE PMHNP-BC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 RED BUG LAKE RD STE 2080
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6835
Country	:	US
Telephone Number	:	833-769-3524
Fax Number	:

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

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	06/09/2026

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