MEDICARE: MAGGIE J WASHINGTON

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	PN5170661	FL
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1477115293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE J WASHINGTON

Provider Business Mailing Address
First Line	:	14710 SCOTTBURGH GLEN DR
Second Line	:
City	:	WIMAUMA
State	:	FL
Zip	:	33598-6206
Country	:	US
Telephone Number	:	813-212-7255
Fax Number	:

Provider Business Practice Location Address
First Line	:	3848 SUN CITY CENTER BLVD STE 104-1097
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33573-6068
Country	:	US
Telephone Number	:	813-212-7255
Fax Number	:

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

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	03/03/2026

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Directions to “ MAGGIE J WASHINGTON ” Practice Location

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