MEDICARE: PEDIATRIC NURSE CONSULTING

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	251E00000X	Home Health Agency	RN2662202	FL
2	251F00000X	Home Infusion Agency	RN2662202	FL
3	251K00000X	Public Health or Welfare Agency	RN2662202	FL
4	251S00000X	Community/Behavioral Health Agency	RN2662202	FL
5	253Z00000X	In Home Supportive Care Agency	RN2662202	FL
6	251J00000X	Nursing Care Agency	RN2662202	FL

General Provider Information

NPI Number	:	1821448531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC NURSE CONSULTING

Provider Business Mailing Address
First Line	:	2913 CULLEN LAKE SHORE DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1038
Country	:	US
Telephone Number	:	407-592-6298
Fax Number	:	407-286-0724

Provider Business Practice Location Address
First Line	:	2913 CULLEN LAKE SHORE DRIVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-1038
Country	:	US
Telephone Number	:	407-592-6298
Fax Number	:	407-286-0724

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MRS. JACQUELINE M TRUMBLE
Credential	:	RN
Telephone Number	:	407-592-6298

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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