Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11015931 | FL |
NPI | 1033872122 |
---|---|
Provider Name | Jaydel D Rayne |
First Address | Zephyrhills, FL 33542-7505 |
Second Address | Wesley Chapel, FL 33544-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2021 |
Last Update Date | 10/12/2021 |