Healthcare Provider Details

I. General information

NPI: 1871413823
Provider Name (Legal Business Name): RAYNIQUE MCCRORY ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S HILL ST APT 3201
LOS ANGELES CA
90014-3298
US

IV. Provider business mailing address

825 S HILL ST APT 3201
LOS ANGELES CA
90014-3298
US

V. Phone/Fax

Practice location:
  • Phone: 727-303-7550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95040305
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95040305
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95040305
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040305
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95040305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: