MEDICARE: MARIA MAGDALENA AUSSENDORF 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	163WH0200X	Home Health Registered Nurse	RN9188861	FL

General Provider Information

NPI Number	:	1295159259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MAGDALENA AUSSENDORF RN

Provider Business Mailing Address
First Line	:	4814 N DARBY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2604
Country	:	US
Telephone Number	:	813-598-7711
Fax Number	:	813-641-9278

Provider Business Practice Location Address
First Line	:	4814 N DARBY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-2604
Country	:	US
Telephone Number	:	813-598-7711
Fax Number	:	813-641-9278

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

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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