Healthcare Provider Details

I. General information

NPI: 1699492181
Provider Name (Legal Business Name): RACQUEL E MARIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACQUEL E HEDMAN GATICA

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N ARNOLD RD UNIT 106
PANAMA CITY BEACH FL
32413-2524
US

IV. Provider business mailing address

2505 HARRISON AVE
PANAMA CITY FL
32405-4464
US

V. Phone/Fax

Practice location:
  • Phone: 850-233-3376
  • Fax: 850-522-8354
Mailing address:
  • Phone: 850-233-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: