MEDICARE: REF NURSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	RN 893792	FL
2	251S00000X	Community/Behavioral Health Agency	SW 6112	FL

General Provider Information

NPI Number	:	1073059812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REF NURSE LLC

Provider Business Mailing Address
First Line	:	1317 INDIAN RIVER AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4220
Country	:	US
Telephone Number	:	321-289-2818
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 S PALM AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-7600
Country	:	US
Telephone Number	:	321-289-2818
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROSA L ESTELA FLINT
Credential	:	RN, LCSW
Telephone Number	:	321-289-2818

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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