Provider Demographics
NPI:1306861125
Name:MINARDI, RAYE E (ARNP)
Entity type:Individual
Prefix:
First Name:RAYE
Middle Name:E
Last Name:MINARDI
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 1:4117 E FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2011
Mailing Address - Country:US
Mailing Address - Phone:813-745-4968
Mailing Address - Fax:813-745-6911
Practice Address - Street 1:4117 E FOWLER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2011
Practice Address - Country:US
Practice Address - Phone:813-745-4968
Practice Address - Fax:813-745-6911
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2844742363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS58929Medicare UPIN
FLE0961ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID