Provider Demographics
NPI:1972247393
Name:DEWEERD, RACHEL LYNN
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:DEWEERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 FLAT ROCK PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4582
Mailing Address - Country:US
Mailing Address - Phone:727-777-2735
Mailing Address - Fax:
Practice Address - Street 1:3112 FLAT ROCK PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4582
Practice Address - Country:US
Practice Address - Phone:727-777-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program