MEDICARE: GREENE PRESERVE INVESTMENT LLC

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

General Provider Information

NPI Number	:	1184218471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENE PRESERVE INVESTMENT LLC

Provider Business Mailing Address
First Line	:	3690 SWEET BUTTERCUP DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2957
Country	:	US
Telephone Number	:	954-249-7230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3690 SWEET BUTTERCUP DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2957
Country	:	US
Telephone Number	:	954-249-7230
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JUDY BUCHANAN
Credential	:	APRN
Telephone Number	:	954-249-7230

Provider Enumeration Date	:	02/26/2021
Last Update Date	:	09/24/2021

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