MEDICARE: MARIE L FELIX LUCIUS 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	RN9321313	FL

General Provider Information

NPI Number	:	1104198993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE L FELIX LUCIUS RN

Provider Business Mailing Address
First Line	:	20621 WHITEWOOD WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3216
Country	:	US
Telephone Number	:	786-326-5694
Fax Number	:

Provider Business Practice Location Address
First Line	:	20621 WHITEWOOD WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3216
Country	:	US
Telephone Number	:	813-973-8919
Fax Number	:

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

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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