MEDICARE: JOHN PAUL BISCANIN

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
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871084541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PAUL BISCANIN

Provider Business Mailing Address
First Line	:	900 SE OCEAN BLVD STE 340
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3502
Country	:	US
Telephone Number	:	772-220-3439
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 SE OCEAN BLVD STE 340
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-3502
Country	:	US
Telephone Number	:	772-220-3439
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	03/11/2024

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