MEDICARE: SAMANTHA TALICIA MCBEAN

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	163WH0200X	Home Health Registered Nurse	334545	FL

General Provider Information

NPI Number	:	1245822691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA TALICIA MCBEAN

Provider Business Mailing Address
First Line	:	1672 BELLA VISTA WAY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-2634
Country	:	US
Telephone Number	:	954-290-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1672 BELLA VISTA WAY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-2634
Country	:	US
Telephone Number	:	954-290-4566
Fax Number	:

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

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	02/08/2021

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