Healthcare Provider Details

I. General information

NPI: 1104789916
Provider Name (Legal Business Name): RACHEL NILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 W SNOWY EGRET PL
CITRUS SPRINGS FL
34434-5736
US

IV. Provider business mailing address

2239 W SNOWY EGRET PL
CITRUS SPRINGS FL
34434-5736
US

V. Phone/Fax

Practice location:
  • Phone: 813-785-1409
  • Fax:
Mailing address:
  • Phone: 813-785-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND7295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: