MEDICARE: AUDREY LLEWELLYN

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	163W00000X	Registered Nurse	RN 9184474	FL

General Provider Information

NPI Number	:	1386824381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY LLEWELLYN

Provider Business Mailing Address
First Line	:	2410 SE RENICK AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 SE RENICK AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-6761
Country	:	US
Telephone Number	:	772-398-5420
Fax Number	:

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

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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Directions to “ AUDREY LLEWELLYN ” Practice Location

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