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General NPI Number Information
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NPI Number | 1417618828
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Entity Type | Individual
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Provider Name | RACHALLE BOUTROS NEHMEH PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 10 SE CENTRAL PKWY STE 100
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City | STUART
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State | FL
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Zip | 34994-5914
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Country | US
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Telephone | 772-303-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 3272 SE WEST SNOW RD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-6527
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Country | US
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Telephone | 772-203-7286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9118885
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License Number State | FL
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