MEDICARE: RAPHAEL GARCIA APRN

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
1	363LG0600X	Gerontology Nurse Practitioner	APRN11034734	FL
2	363LA2200X	Adult Health Nurse Practitioner	APRN11034734	FL

General Provider Information

NPI Number	:	1548078140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAPHAEL GARCIA APRN

Provider Business Mailing Address
First Line	:	4338 SWIFT CIR
Second Line	:
City	:	VALRICO
State	:	FL
Zip	:	33596-7247
Country	:	US
Telephone Number	:	727-741-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 W HILLSBOROUGH AVE STE 100
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-1059
Country	:	US
Telephone Number	:	813-872-4492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2024
Last Update Date	:	02/23/2025

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