MEDICARE: MS. RESHETA HALLOWAY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1336348358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RESHETA HALLOWAY

Provider Business Mailing Address
First Line	:	3825 HENDERSON BLVD
Second Line	:	SUITE 505
City	:	TAMPA
State	:	FL
Zip	:	33629-5037
Country	:	US
Telephone Number	:	813-281-5535
Fax Number	:	813-281-5538

Provider Business Practice Location Address
First Line	:	3825 HENDERSON BLVD
Second Line	:	SUITE 505
City	:	TAMPA
State	:	FL
Zip	:	33629-5037
Country	:	US
Telephone Number	:	813-281-5535
Fax Number	:	813-281-5538

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	08/22/2007

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