Healthcare Provider Details

I. General information

NPI: 1902734056
Provider Name (Legal Business Name): RAVEN RANSAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 SW 130TH PL
OCALA FL
34473-9053
US

IV. Provider business mailing address

3251 SW 130TH PL
OCALA FL
34473-9053
US

V. Phone/Fax

Practice location:
  • Phone: 954-253-2733
  • Fax:
Mailing address:
  • Phone: 954-253-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9488943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: