Healthcare Provider Details

I. General information

NPI: 1053102756
Provider Name (Legal Business Name): MICHELLE A RAINEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8916 MADRID CIR
NAPLES FL
34104-6227
US

IV. Provider business mailing address

8916 MADRID CIR
NAPLES FL
34104-6227
US

V. Phone/Fax

Practice location:
  • Phone: 239-484-0288
  • Fax:
Mailing address:
  • Phone: 239-484-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9583472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: