MEDICARE: MS. CARI JEAN TANELLA RN-IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	RN919187	FL

General Provider Information

NPI Number	:	1174879092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARI JEAN TANELLA RN-IBCLC

Provider Business Mailing Address
First Line	:	8414 SICILIANO ST
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-7165
Country	:	US
Telephone Number	:	561-302-3871
Fax Number	:

Provider Business Practice Location Address
First Line	:	8414 SICILIANO ST
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-7165
Country	:	US
Telephone Number	:	561-302-3871
Fax Number	:

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

Provider Enumeration Date	:	07/29/2012
Last Update Date	:	02/02/2022

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