MEDICARE: MS. NATALIE DAWN PACKER LICENSED PRACTICAL N

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	164W00000X	Licensed Practical Nurse	0943321	FL

General Provider Information

NPI Number	:	1447378989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NATALIE DAWN PACKER LICENSED PRACTICAL N

Provider Business Mailing Address
First Line	:	405 S DALE MABRY HWY
Second Line	:	#115
City	:	TAMPA
State	:	FL
Zip	:	33609
Country	:	US
Telephone Number	:	813-760-6111
Fax Number	:	813-874-2304

Provider Business Practice Location Address
First Line	:	1609 BOWMAN AVE
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567
Country	:	US
Telephone Number	:	813-752-0032
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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