MEDICARE: NURSE KNACKS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1407675564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE KNACKS

Provider Business Mailing Address
First Line	:	6020 STRAWBERRY LAKES CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6509
Country	:	US
Telephone Number	:	561-306-5343
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 STRAWBERRY LAKES CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-6509
Country	:	US
Telephone Number	:	561-306-5343
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHIA CAJUSTE
Credential	:	NP
Telephone Number	:	561-306-5343

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/17/2024

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