MEDICARE: VERNA GALLUPPO RN, CCM

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	163WC0400X	Case Management Registered Nurse	RN3288862	FL

General Provider Information

NPI Number	:	1952142762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNA GALLUPPO RN, CCM

Provider Business Mailing Address
First Line	:	1391 NW 136TH AVE
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-2800
Country	:	US
Telephone Number	:	813-362-9208
Fax Number	:	770-723-8767

Provider Business Practice Location Address
First Line	:	4529 GLEN HOLW
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-5533
Country	:	US
Telephone Number	:	813-841-1547
Fax Number	:	770-723-8767

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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