Provider Demographics
NPI:1538242334
Name:MINISTRE, RAQUELLE ALICIA (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUELLE
Middle Name:ALICIA
Last Name:MINISTRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RAQUELLE
Other - Middle Name:ALICIA
Other - Last Name:HEADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5245 41ST ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-1619
Mailing Address - Country:US
Mailing Address - Phone:772-774-7989
Mailing Address - Fax:772-774-7990
Practice Address - Street 1:5245 41ST ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-1619
Practice Address - Country:US
Practice Address - Phone:772-774-7986
Practice Address - Fax:772-774-7990
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000518100Medicaid
FL000518100Medicaid
FL000518100Medicaid
FLAR986ZMedicare PIN