Provider Demographics
NPI:1033088471
Name:ODIETE, RAQUEL M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:M
Last Name:ODIETE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29800 SW 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3666
Mailing Address - Country:US
Mailing Address - Phone:305-989-5201
Mailing Address - Fax:
Practice Address - Street 1:29800 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3666
Practice Address - Country:US
Practice Address - Phone:305-989-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11043237363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health