MEDICARE: ROBERTA PIERRE

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	171W00000X	Contractor	233862	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275910218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA PIERRE

Provider Business Mailing Address
First Line	:	10960 BEACH BLVD LOT 32
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4831
Country	:	US
Telephone Number	:	904-328-6904
Fax Number	:	904-328-6946

Provider Business Practice Location Address
First Line	:	10960 BEACH BLVD LOT 32
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4831
Country	:	US
Telephone Number	:	904-328-6904
Fax Number	:	904-328-6946

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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Directions to “ ROBERTA PIERRE ” Practice Location

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