Basic Information
| Provider Information | |||||||||
| NPI: | 1548425788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DITRAPANI | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ABIGAIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 SHIRCLIFF WAY | ||||||||
| Address2: | SUITE 724 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043087959 | ||||||||
| FaxNumber: | 9043087938 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 SHIRCLIFF WAY | ||||||||
| Address2: | SUITE 724 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322044786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043087959 | ||||||||
| FaxNumber: | 9043087938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | ME102341 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 14M3L | 01 | BCBS-FL | OTHER | 006373200 | 05 | FL | MEDICAID | P01085558 | 01 | FL | RAILROAD MEDICARE | OTHER | 356723 | 01 | FL | AVMED | OTHER |