Healthcare Provider Details

I. General information

NPI: 1871914275
Provider Name (Legal Business Name): JUDENIE RAPHAEL AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 11/27/2023
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 N LAURA ST
JACKSONVILLE FL
32206-4912
US

IV. Provider business mailing address

1128 N LAURA ST
JACKSONVILLE FL
32206-4912
US

V. Phone/Fax

Practice location:
  • Phone: 904-344-3403
  • Fax: 904-355-4149
Mailing address:
  • Phone: 904-344-3403
  • Fax: 904-355-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9502265
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9502265
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: