Healthcare Provider Details

I. General information

NPI: 1245477181
Provider Name (Legal Business Name): RACHEL MCMAHAN THOMAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL L MCMAHAN ARNP

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 W LOWDER ST
MACCLENNY FL
32063-2664
US

IV. Provider business mailing address

480 W LOWDER ST
MACCLENNY FL
32063-2664
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-6291
  • Fax: 904-259-4761
Mailing address:
  • Phone: 904-259-6291
  • Fax: 904-259-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number3397642
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3397642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: