MEDICARE: CAMILLA MINUS

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	3747P1801X	Personal Care Attendant	CNA124830	FL
2	376K00000X	Nurse's Aide	CNA124830	FL
3	172V00000X	Community Health Worker
4	374U00000X	Home Health Aide
5	163WH0200X	Home Health Registered Nurse	RN9178180	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356764369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLA MINUS

Provider Business Mailing Address
First Line	:	PO BOX 651521
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32965-1521
Country	:	US
Telephone Number	:	772-205-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	5112 LA SALLE ST APT A
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-5035
Country	:	US
Telephone Number	:	772-205-7028
Fax Number	:

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

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	07/15/2016

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Directions to “ CAMILLA MINUS ” Practice Location

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