MEDICARE: MARY JEAN HYDE WHITE REGISTERED NURSE

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	163W00000X	Registered Nurse	RN2777682	FL

General Provider Information

NPI Number	:	1720598824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JEAN HYDE WHITE REGISTERED NURSE

Provider Business Mailing Address
First Line	:	5440 CHISWICK CIR
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-2117
Country	:	US
Telephone Number	:	407-300-7152
Fax Number	:

Provider Business Practice Location Address
First Line	:	5440 CHISWICK CIR
Second Line	:
City	:	BELLE ISLE
State	:	FL
Zip	:	32812-2117
Country	:	US
Telephone Number	:	407-300-7152
Fax Number	:

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

Provider Enumeration Date	:	10/03/2017
Last Update Date	:	10/03/2017

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