MEDICARE: CAMERON MUNN

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	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7004	OTHER	FL	LICENSED DIETITIAN/NUTRITIONIST
2	86025814	OTHER		REGISTERED DIETITIAN NUTRITIONIST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154893535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON MUNN

Provider Business Mailing Address
First Line	:	1517A OSCEOLA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517A OSCEOLA ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4305
Country	:	US
Telephone Number	:	757-284-6119
Fax Number	:

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

Provider Enumeration Date	:	12/22/2018
Last Update Date	:	12/22/2018

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Directions to “ CAMERON MUNN ” Practice Location

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