MEDICARE: KAREN LYNETTE LANGLEY CNA

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	376K00000X	Nurse's Aide	105691	FL

General Provider Information

NPI Number	:	1346833316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LYNETTE LANGLEY CNA

Provider Business Mailing Address
First Line	:	4207 ORLANDO AVE
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8013
Country	:	US
Telephone Number	:	352-364-7000
Fax Number	:	352-777-4167

Provider Business Practice Location Address
First Line	:	4207 ORLANDO AVE
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-8013
Country	:	US
Telephone Number	:	352-364-7000
Fax Number	:	352-777-4167

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

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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