MEDICARE: MSB INTEGRATIVE PRIMARY CARE LLC

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	363L00000X	Nurse Practitioner	ARNP2672012	FL

General Provider Information

NPI Number	:	1932529948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSB INTEGRATIVE PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	12002 ANCHOR WAY
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33778-2507
Country	:	US
Telephone Number	:	386-682-9644
Fax Number	:

Provider Business Practice Location Address
First Line	:	29901 US HIGHWAY 19 N
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-1041
Country	:	US
Telephone Number	:	727-286-6203
Fax Number	:

Authorized Official
Title or Position	:	OWNER & PRESIDENT
Name	:	SANDRA LEE BRITT
Credential	:	ARNP
Telephone Number	:	727-447-3434

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	06/16/2014

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