Provider Demographics
NPI:1417618828
Name:NEHMEH, RACHALLE BOUTROS (PA-C)
Entity type:Individual
Prefix:
First Name:RACHALLE
Middle Name:BOUTROS
Last Name:NEHMEH
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 SE WEST SNOW RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6527
Mailing Address - Country:US
Mailing Address - Phone:772-203-7286
Mailing Address - Fax:
Practice Address - Street 1:10 SE CENTRAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5914
Practice Address - Country:US
Practice Address - Phone:772-303-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty