MEDICARE: MS. STEPHANIE ROZELL DAVIS RN

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	163WS0200X	School Registered Nurse	RN3064912	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	:	1558335513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ROZELL DAVIS RN

Provider Business Mailing Address
First Line	:	PO BOX 93556
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33804-3556
Country	:	US
Telephone Number	:	863-860-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 CANDYCE AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-1203
Country	:	US
Telephone Number	:	863-860-8555
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/14/2009

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