MEDICARE: MARK AVERY

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1437802766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK AVERY

Provider Business Mailing Address
First Line	:	4501 BRIDGETON LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3828
Country	:	US
Telephone Number	:	321-370-3300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 BRIDGETON LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-3828
Country	:	US
Telephone Number	:	321-370-3300
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/28/2022

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Directions to “ MARK AVERY ” Practice Location

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