MEDICARE: FABIOLA JUSTE

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	363LG0600X	Gerontology Nurse Practitioner	AG02230031	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AG02230031	OTHER	FL	AANP

General Provider Information

NPI Number	:	1306543657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIOLA JUSTE

Provider Business Mailing Address
First Line	:	5511 LIGHTHOUSE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-5956
Country	:	US
Telephone Number	:	407-334-3918
Fax Number	:

Provider Business Practice Location Address
First Line	:	5511 LIGHTHOUSE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-5956
Country	:	US
Telephone Number	:	407-334-3918
Fax Number	:

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

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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Directions to “ FABIOLA JUSTE ” Practice Location

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