Provider Demographics
NPI:1912667064
Name:CENTENO, RACHEL LEIGH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEIGH
Last Name:CENTENO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:801 E 6TH ST STE 307
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3663
Practice Address - Country:US
Practice Address - Phone:850-804-3823
Practice Address - Fax:850-608-6423
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2024-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9115505363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant