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NPI Code Detail

MEDICARE: RANAE S BERRY PA-C

MEDICARE: RANAE S BERRY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA21515CA
2363A00000XPhysician AssistantPA2009-0035NM
3363A00000XPhysician AssistantPA9103545FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033192349
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANAE S BERRY PA-C
Provider Business Mailing Address
First Line : 18167 US HIGHWAY 19 N
Second Line : SUITE650
City : CLEARWATER
State : FL
Zip : 33764-3528
Country : US
Telephone Number : 727-507-3624
Fax Number : 727-530-0147
Provider Business Practice Location Address
First Line : 1431 SW 1ST AVE
Second Line :
City : OCALA
State : FL
Zip : 34471-6500
Country : US
Telephone Number : 352-401-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 08/16/2024

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Directions to “ RANAE S BERRY PA-C” Practice Location

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