Provider Demographics
NPI:1346511870
Name:HOLDER, RACHAEL LILLIE (CRNA)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:LILLIE
Last Name:HOLDER
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LILLIE
Other - Last Name:DAVALOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7206
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:9320 US HIGHWAY 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-6300
Practice Address - Country:US
Practice Address - Phone:813-471-0000
Practice Address - Fax:656-233-5024
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193684367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered