MEDICARE: RACHEL LEE SANG ARNP

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	363LF0000X	Family Nurse Practitioner	9235546	FL

General Provider Information

NPI Number	:	1902372816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL LEE SANG ARNP

Provider Business Mailing Address
First Line	:	4230 PABLO PROFESSIONAL CT STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-3223
Country	:	US
Telephone Number	:	904-329-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 N SEMORAN BLVD STE 100
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3568
Country	:	US
Telephone Number	:	321-804-9110
Fax Number	:

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

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	10/17/2018

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