Provider Demographics
NPI:1316286776
Name:RASCO, STEPHEN W (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:W
Last Name:RASCO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6594 AVENIDA DE GALVEZ
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8916
Mailing Address - Country:US
Mailing Address - Phone:256-338-0442
Mailing Address - Fax:
Practice Address - Street 1:13909 NACOGDOCHES RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1296
Practice Address - Country:US
Practice Address - Phone:210-655-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9386243363L00000X
CA22058363LF0000X
TXAP142306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily