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General NPI Number Information
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NPI Number | 1740610294
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Entity Type | Individual
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Provider Name | HOLLY RAFFERTY PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 1368 N UNIVERSITY DR
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City | PLANTATION
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State | FL
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Zip | 33322-4734
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Country | US
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Telephone | 954-577-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 19492 SATURNIA LAKES DR
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City | BOCA RATON
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State | FL
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Zip | 33498-6206
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Country | US
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Telephone | 561-271-7959
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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 | PA9107513
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License Number State | FL
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