MEDICARE: SELENA JIMMIEKO COBB CNA

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	376K00000X	Nurse's Aide	218096	FL

General Provider Information

NPI Number	:	1225318157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA JIMMIEKO COBB CNA

Provider Business Mailing Address
First Line	:	1124 ANDREW AVILES CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5006
Country	:	US
Telephone Number	:	813-802-7219
Fax Number	:	813-246-5079

Provider Business Practice Location Address
First Line	:	1124 ANDREW AVILES CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5006
Country	:	US
Telephone Number	:	813-802-7219
Fax Number	:	813-246-5079

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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