MEDICARE: MR. LUIS ALBERTO PALMA LPN

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	PN5250807	FL

General Provider Information

NPI Number	:	1447913652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUIS ALBERTO PALMA LPN

Provider Business Mailing Address
First Line	:	10435 ROCKING A RUN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-4808
Country	:	US
Telephone Number	:	407-490-8684
Fax Number	:

Provider Business Practice Location Address
First Line	:	10435 ROCKING A RUN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-4808
Country	:	US
Telephone Number	:	407-490-8684
Fax Number	:

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	10/15/2021

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