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General NPI Number Information
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NPI Number | 1760518906
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Entity Type | Individual
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Provider Name | RACHEL LOUISE EMBRY PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 414 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5010
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Country | US
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Telephone | 813-684-5255
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Fax |
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Provider Business Mailing Address
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Address Line | 1805 PRINCETON LAKES DR APT.# 210
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City | BRANDON
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State | FL
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Zip | 33511-2228
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Country | US
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Telephone | 615-554-6770
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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 | PA9104102
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License Number State | FL
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