Rachael Proveaux

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11021125 Issued in FL

Practice address

3003 Texas Trail LN
Manvel, TX 77578-3263

Phone

(843) 908-4438

NPI assigned

Mar 27, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Rachael Tombolesi Former name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Wound Care, LLCGroup PAC ID 7214394972, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Wound Care, LLC

  • Wound Care Registered Nurse
  • Tampa, FL
  • NPI 1356036354
  Medicare reassignment Care Compare group NPD
• Wound Technology Network Inc

  • Infectious Disease Physician
  • Orlando, FL
  • NPI 1962601393
  Medicare reassignment NPD
• WT Health of Florida LLC

  • Infectious Disease Physician
  • Orlando, FL
  • NPI 1982434106
  Medicare reassignment NPD
• Wound Management Specialists, LLC

  • Nurse Practitioner
  • Flowood, MS
  • NPI 1972150084

  FL

  Medicare reassignment
• Wound Technology Network

  • Podiatrist
  • Hollywood, FL
  • NPI 1831397041
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1457001992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8422 TAMPA POINT BLVD",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336211405",
            "telephone_number": "843-908-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 TEXAS TRAIL LN",
            "city": "MANVEL",
            "state": "TX",
            "postal_code": "775783263",
            "telephone_number": "843-908-4438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVEAUX",
        "first_name": "RACHAEL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-27",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11021125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHAEL",
            "last_name": "TOMBOLESI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon Elizabeth Payne, D.C., LMT
• Taiwan De'Qusie Piles, LPC-A, CRC, CVE
• James Poenitzsch, PT, DPT, COMT, CSCS
• Molly Poenitzsch, PT, DPT
• Prestige Medical P a
• Provider Plus LLC
• Peggy Pryor
• PT Mobile Clinic
• Queen of Safety Supply Co., LLC
• Rafa Pharmaceuticals LLC

• Family Nurse Practitioner in Manvel, TX
• Providers in Manvel, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.