Healthcare Provider Details

I. General information

NPI: 1235911678
Provider Name (Legal Business Name): TINA M RAHE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA RAHE APRN PMHNP-BC

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 LAKE WORTH RD #1089
LAKE WORTH FL
33467
US

IV. Provider business mailing address

1025 GATEWAY BLVD STE 303-355
BOYNTON BEACH FL
33426-8348
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-2560
  • Fax: 855-595-2704
Mailing address:
  • Phone: 561-714-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9551401
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN9551401
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11029520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: