Healthcare Provider Details

I. General information

NPI: 1144909540
Provider Name (Legal Business Name): HARRIET AVILA RAYMUNDO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8342 US HIGHWAY 301 N
PARRISH FL
34219-8653
US

IV. Provider business mailing address

8342 US HIGHWAY 301 N
PARRISH FL
34219-8653
US

V. Phone/Fax

Practice location:
  • Phone: 941-729-4400
  • Fax: 941-729-4424
Mailing address:
  • Phone: 941-729-4400
  • Fax: 941-729-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11040946
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: