Provider Demographics
NPI:1104018589
Name:RATTANAKORN, URAIRONG (NP)
Entity type:Individual
Prefix:MRS
First Name:URAIRONG
Middle Name:
Last Name:RATTANAKORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14001 NW 4TH ST
Mailing Address - Street 2:#202
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2297
Mailing Address - Country:US
Mailing Address - Phone:954-391-9687
Mailing Address - Fax:954-391-9687
Practice Address - Street 1:14001 NW 4TH ST
Practice Address - Street 2:#202
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2297
Practice Address - Country:US
Practice Address - Phone:954-391-9687
Practice Address - Fax:954-391-9687
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3159562363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health