MEDICARE: MS. MICHELINE LYNCEE

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	678233796	FL

General Provider Information

NPI Number	:	1427487511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELINE LYNCEE

Provider Business Mailing Address
First Line	:	2907 N BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-1207
Country	:	US
Telephone Number	:	813-221-5114
Fax Number	:	813-221-4744

Provider Business Practice Location Address
First Line	:	2907 N BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-1207
Country	:	US
Telephone Number	:	813-221-5114
Fax Number	:	813-221-4744

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

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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