MEDICARE: BRENDA K PAQUIN ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARNP2690222	FL

General Provider Information

NPI Number	:	1306075130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA K PAQUIN ARNP

Provider Business Mailing Address
First Line	:	6503 CATHEDRAL OAKS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-6123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6503 CATHEDRAL OAKS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33565-6123
Country	:	US
Telephone Number	:	813-558-6600
Fax Number	:

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	05/16/2016

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