Healthcare Provider Details

I. General information

NPI: 1851811616
Provider Name (Legal Business Name): RACHEL HOLLENBACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 BAYMEADOWS RD STE 2
JACKSONVILLE FL
32217-4676
US

IV. Provider business mailing address

4217 BAYMEADOWS RD STE 2
JACKSONVILLE FL
32217-4676
US

V. Phone/Fax

Practice location:
  • Phone: 904-332-7431
  • Fax: 904-332-7408
Mailing address:
  • Phone: 904-332-7431
  • Fax: 904-332-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN3150732
License Number StateFL

VIII. Authorized Official

Name: WENDY C LU
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 904-221-2535