MEDICARE: MS. DOLORES SELENA SERRECCHIA BSN

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	163WP0200X	Pediatric Registered Nurse	1955832	FL

General Provider Information

NPI Number	:	1043232630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOLORES SELENA SERRECCHIA BSN

Provider Business Mailing Address
First Line	:	1261 NW 193RD AVE
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-3221
Country	:	US
Telephone Number	:	305-547-2500
Fax Number	:	305-547-2673

Provider Business Practice Location Address
First Line	:	1477 NW 8TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33136-1425
Country	:	US
Telephone Number	:	305-547-2500
Fax Number	:	305-547-2673

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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