MEDICARE: ELIZABETH EMDEN RN, BSN

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	163WS0200X	School Registered Nurse	RN9528234	FL

General Provider Information

NPI Number	:	1316615792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH EMDEN RN, BSN

Provider Business Mailing Address
First Line	:	3319 BAYSHORE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8899
Country	:	US
Telephone Number	:	813-839-5371
Fax Number	:	813-839-1486

Provider Business Practice Location Address
First Line	:	3319 BAYSHORE BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8899
Country	:	US
Telephone Number	:	813-839-5371
Fax Number	:	813-839-1486

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

Provider Enumeration Date	:	09/01/2021
Last Update Date	:	09/01/2021

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