MEDICARE: MRS. HOLLY LYNN BOGART R.N.

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	163WS0200X	School Registered Nurse	3190172	FL

General Provider Information

NPI Number	:	1124112552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY LYNN BOGART R.N.

Provider Business Mailing Address
First Line	:	10565 S.E. 42ND CT.
Second Line	:
City	:	BELLEVIEW
State	:	FL
Zip	:	34420
Country	:	US
Telephone Number	:	352-307-2485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 S.E.32ND AVE.
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34478
Country	:	US
Telephone Number	:	352-629-0137
Fax Number	:	352-659-2043

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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