Healthcare Provider Details

I. General information

NPI: 1194735688
Provider Name (Legal Business Name): RACHEL E CARECCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 NORTHDALE BLVD STE 200
TAMPA FL
33624-1863
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 813-712-5702
  • Fax: 813-377-1005
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME96058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: