MEDICARE: CARLA RENE HILL

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	374U00000X	Home Health Aide	L18000227748	FL

General Provider Information

NPI Number	:	1225593981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA RENE HILL

Provider Business Mailing Address
First Line	:	PO BOX 1206
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32041-1206
Country	:	US
Telephone Number	:	904-548-7099
Fax Number	:

Provider Business Practice Location Address
First Line	:	97199 HARBOR CONCOURSE CIR
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-3873
Country	:	US
Telephone Number	:	904-335-0326
Fax Number	:

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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