Healthcare Provider Details

I. General information

NPI: 1346511870
Provider Name (Legal Business Name): RACHAEL LILLIE HOLDER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL LILLIE DAVALOS CRNA

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

PO BOX 95004
LAKELAND FL
33804-5004
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-0000
  • Fax: 656-233-5024
Mailing address:
  • Phone: 863-680-7206
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9193684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: