MEDICARE: GRACIE-ANN NATAUYA COKE

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	251E00000X	Home Health Agency
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1093450256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIE-ANN NATAUYA COKE

Provider Business Mailing Address
First Line	:	5249 MILLENIA BLVD APT 109
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6176
Country	:	US
Telephone Number	:	570-415-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	5249 MILLENIA BLVD APT 109
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-6176
Country	:	US
Telephone Number	:	570-415-2345
Fax Number	:

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

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/06/2022

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