MEDICARE: MS. ERICA D LEE CNA

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	376K00000X	Nurse's Aide	324069	FL

General Provider Information

NPI Number	:	1770246639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERICA D LEE CNA

Provider Business Mailing Address
First Line	:	824 MANATEE AVE W PO BOX 131
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34206-0131
Country	:	US
Telephone Number	:	941-592-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 MANATEE AVE W STE L106
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-2364
Country	:	US
Telephone Number	:	941-592-4427
Fax Number	:

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

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/19/2021

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