Healthcare Provider Details

I. General information

NPI: 1205081783
Provider Name (Legal Business Name): RACHEL E. NETTLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-8183
  • Fax: 352-392-9802
Mailing address:
  • Phone: 352-392-8183
  • Fax: 352-392-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberARNP9219689
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10/18/2008 04/30/20
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: