MEDICARE: MS. JUDY CZIOTKA TALTON MSN/ARNP

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	363LA2100X	Acute Care Nurse Practitioner	ARNP 9203768	FL
2	363LA2100X	Acute Care Nurse Practitioner	ARNP9203768	FL

General Provider Information

NPI Number	:	1912223967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDY CZIOTKA TALTON MSN/ARNP

Provider Business Mailing Address
First Line	:	4750 SW 91ST DR STE A
Second Line	:	4809 SW 91ST TERRACE
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-8140
Country	:	US
Telephone Number	:	352-367-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 SW 91ST DR STE A
Second Line	:	4809 SW 91ST TERRACE
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-8140
Country	:	US
Telephone Number	:	352-367-9602
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	06/20/2012

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