MEDICARE: MRS. CAROLYN ANN REIKENIS ARNP

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	363L00000X	Nurse Practitioner	ARNP1004002	FL

General Provider Information

NPI Number	:	1366462392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN ANN REIKENIS ARNP

Provider Business Mailing Address
First Line	:	701 WARREN DR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-4036
Country	:	US
Telephone Number	:	561-745-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CONTINENTAL DR
Second Line	:	STE A FMC DIALYSIS SERVICES WPB, CKD SERVICES
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3207
Country	:	US
Telephone Number	:	561-840-4141
Fax Number	:	561-840-4011

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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