MEDICARE: LETINA MICHELLE FLOWERS APRN

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	APRN11001254	FL

General Provider Information

NPI Number	:	1114577475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETINA MICHELLE FLOWERS APRN

Provider Business Mailing Address
First Line	:	211 CROWN WHEEL CIR
Second Line	:
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-8216
Country	:	US
Telephone Number	:	904-994-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 CROWN WHEEL CIR
Second Line	:
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-8216
Country	:	US
Telephone Number	:	904-994-6030
Fax Number	:

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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