MEDICARE: ZINA KISLAOUSKENE

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	251E00000X	Home Health Agency	30211032	FL

General Provider Information

NPI Number	:	1346411444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZINA KISLAOUSKENE

Provider Business Mailing Address
First Line	:	8206 EAGLES PARK DR N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-7007
Country	:	US
Telephone Number	:	727-549-0489
Fax Number	:	727-545-9623

Provider Business Practice Location Address
First Line	:	8206 EAGLES PARK DR N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33709-7007
Country	:	US
Telephone Number	:	727-549-0489
Fax Number	:	727-545-9623

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ZINA LINA KISLAOUSKENE
Credential	:	MEDICAL NURSE
Telephone Number	:	727-549-0489

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	06/18/2008

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