Healthcare Provider Details

I. General information

NPI: 1780388595
Provider Name (Legal Business Name): RACQUILLE ABIGAIL REID MBBS, BMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
MANGONIA PARK FL
33407-2413
US

IV. Provider business mailing address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4668
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6300
  • Fax: 561-882-6124
Mailing address:
  • Phone: 954-938-3359
  • Fax: 954-492-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME180842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: