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General NPI Number Information
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NPI Number | 1548246606
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Entity Type | Individual
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Provider Name | ALLISON ANNE RACO PAC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 12/03/2013
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Provider Practice Location Address
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Address Line | 7000 SPYGLASS CT STE 220
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City | VIERA
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State | FL
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Zip | 32940-8288
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Country | US
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Telephone | 321-752-5994
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Fax | 321-752-5494
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Provider Business Mailing Address
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Address Line | 1286 FLORIDA AVE S
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City | ROCKLEDGE
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State | FL
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Zip | 32955-2484
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Country | US
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Telephone | 321-636-7780
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Fax | 321-636-1150
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101101
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License Number State | FL
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