MEDICARE: BRYNNE ODIOSO

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841633047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNNE ODIOSO

Provider Business Mailing Address
First Line	:	609 S GLEN AVE
Second Line	:	UNIT E
City	:	TAMPA
State	:	FL
Zip	:	33609-4682
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 S GLEN AVE
Second Line	:	UNIT E
City	:	TAMPA
State	:	FL
Zip	:	33609-4682
Country	:	US
Telephone Number	:	813-490-5490
Fax Number	:

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	04/08/2013

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Directions to “ BRYNNE ODIOSO ” Practice Location

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