MEDICARE: RONA MCCULLOUGH

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1457909673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONA MCCULLOUGH

Provider Business Mailing Address
First Line	:	2733 GLENVIEW DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5246
Country	:	US
Telephone Number	:	813-362-2234
Fax Number	:

Provider Business Practice Location Address
First Line	:	2733 GLENVIEW DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5246
Country	:	US
Telephone Number	:	813-362-2234
Fax Number	:

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

Provider Enumeration Date	:	08/30/2019
Last Update Date	:	08/30/2019

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Directions to “ RONA MCCULLOUGH ” Practice Location

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