MEDICARE: MS. ALLISON ANNE RACO PAC

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	363AM0700X	Medical Physician Assistant	PA9101101	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00369245	OTHER	FL	RR MEDICARE

General Provider Information

NPI Number	:	1548246606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALLISON ANNE RACO PAC

Provider Business Mailing Address
First Line	:	1286 FLORIDA AVE S
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2484
Country	:	US
Telephone Number	:	321-636-7780
Fax Number	:	321-636-1150

Provider Business Practice Location Address
First Line	:	7000 SPYGLASS CT
Second Line	:	STE 220
City	:	VIERA
State	:	FL
Zip	:	32940-8288
Country	:	US
Telephone Number	:	321-752-5994
Fax Number	:	321-752-5494

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	12/03/2013

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