Provider Demographics
NPI:1225385818
Name:RAIKES HARTLEY, ANN MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:RAIKES HARTLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3738
Mailing Address - Country:US
Mailing Address - Phone:407-569-1260
Mailing Address - Fax:833-963-0109
Practice Address - Street 1:3185 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3738
Practice Address - Country:US
Practice Address - Phone:407-569-1260
Practice Address - Fax:833-963-0109
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3179612363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006434700Medicaid
FLYOE13OtherBCBS
FLGK7937Medicare Oscar/Certification