Provider Demographics
NPI:1730596636
Name:RACITI, AUDRIEANNA ELEASE (FNP)
Entity type:Individual
Prefix:
First Name:AUDRIEANNA
Middle Name:ELEASE
Last Name:RACITI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6302
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:110 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6302
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2014-07-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33338830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03946710Medicaid
NY03946710Medicaid