Provider Demographics
NPI:1861191876
Name:RAKES, JASON TYRELL
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TYRELL
Last Name:RAKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 CALLISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7002
Mailing Address - Country:US
Mailing Address - Phone:813-652-2823
Mailing Address - Fax:
Practice Address - Street 1:1203 CALLISTA AVE
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7002
Practice Address - Country:US
Practice Address - Phone:813-652-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide