Healthcare Provider Details

I. General information

NPI: 1194290528
Provider Name (Legal Business Name): RAQUEL MCCRANIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 ORCHARD HIGHLANDS DR
PALM HARBOR FL
34684-4137
US

IV. Provider business mailing address

2615 ORCHARD HIGHLANDS DR
PALM HARBOR FL
34684-4137
US

V. Phone/Fax

Practice location:
  • Phone: 727-729-9086
  • Fax:
Mailing address:
  • Phone: 727-729-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19314
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: