MEDICARE: EMELIE GONZALES IGNACIO

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	163W00000X	Registered Nurse	RN9444728	FL

General Provider Information

NPI Number	:	1285381921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMELIE GONZALES IGNACIO

Provider Business Mailing Address
First Line	:	1330 BELLEAIR RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2241
Country	:	US
Telephone Number	:	727-637-8454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 BELLEAIR RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2241
Country	:	US
Telephone Number	:	727-637-8454
Fax Number	:

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

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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