MEDICARE: PURE NATURAL MEDICINE, PA

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	171100000X	Acupuncturist	AP3095	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C00LM	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1144643362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE NATURAL MEDICINE, PA

Provider Business Mailing Address
First Line	:	424 N PARK AVE
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4152
Country	:	US
Telephone Number	:	407-682-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 N PARK AVE
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-4152
Country	:	US
Telephone Number	:	407-682-3632
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHEILA LYNN SCOTT
Credential	:	AP
Telephone Number	:	407-682-3632

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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