MEDICARE: MS. CATHALEEN ANN CONNORS C.N.A

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	171W00000X	Contractor	CNA 49161	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	:	1831167600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHALEEN ANN CONNORS C.N.A

Provider Business Mailing Address
First Line	:	3131 JUNIPER DR
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-6209
Country	:	US
Telephone Number	:	386-428-0677
Fax Number	:	386-428-0677

Provider Business Practice Location Address
First Line	:	3131 JUNIPER DR
Second Line	:
City	:	EDGEWATER
State	:	FL
Zip	:	32141-6209
Country	:	US
Telephone Number	:	386-428-0677
Fax Number	:	386-428-0677

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/31/2013

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