MEDICARE: CAROLE ANN FITZGERALD BA, FL-CBA

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	103K00000X	Behavior Analyst	0217	FL

General Provider Information

NPI Number	:	1386876910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLE ANN FITZGERALD BA, FL-CBA

Provider Business Mailing Address
First Line	:	5586 LIGUSTRUM LOOP
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7996
Country	:	US
Telephone Number	:	407-359-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	4541 ALRIX DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-3160
Country	:	US
Telephone Number	:	407-489-2121
Fax Number	:	407-382-2458

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

Provider Enumeration Date	:	08/15/2009
Last Update Date	:	08/15/2009

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