Provider Demographics
NPI:1275372153
Name:PHILLIPS, RACHELL (APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RACHELL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:RACHELL
Other - Middle Name:
Other - Last Name:MANSARAY, WILSON, WEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5213 LEE ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1530
Mailing Address - Country:US
Mailing Address - Phone:856-397-6367
Mailing Address - Fax:
Practice Address - Street 1:5213 LEE ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1530
Practice Address - Country:US
Practice Address - Phone:856-397-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily