MEDICARE: MARY WORRELL RN

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	163W00000X	Registered Nurse	9331511	FL

General Provider Information

NPI Number	:	1083161533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WORRELL RN

Provider Business Mailing Address
First Line	:	5330 POINTE VISTA CIR APT 308
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839
Country	:	US
Telephone Number	:	321-347-4971
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 POINTE VISTA CIR APT 308
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-8446
Country	:	US
Telephone Number	:	321-347-4971
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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