MEDICARE: ROSELYN DUHAYLUNGSOD

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	163WE0003X	Emergency Registered Nurse	RN9191859	FL

General Provider Information

NPI Number	:	1326406885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELYN DUHAYLUNGSOD

Provider Business Mailing Address
First Line	:	1061 WATERFALL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6843
Country	:	US
Telephone Number	:	904-982-6053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 WATERFALL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6843
Country	:	US
Telephone Number	:	904-982-6053
Fax Number	:

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	01/29/2016

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