Healthcare Provider Details

I. General information

NPI: 1548721830
Provider Name (Legal Business Name): SOPHIA DANIELLE RAZIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 CITRUS TOWER BLVD
CLERMONT FL
34711-1909
US

IV. Provider business mailing address

1371 CITRUS TOWER BLVD
CLERMONT FL
34711-1909
US

V. Phone/Fax

Practice location:
  • Phone: 352-708-4828
  • Fax:
Mailing address:
  • Phone: 352-708-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11001404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: