MEDICARE: MRS. CORALIE PRINCE RN

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	177F00000X	Lodging Provider	AL11411	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497998371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CORALIE PRINCE RN

Provider Business Mailing Address
First Line	:	2440 EMERSON DR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4972
Country	:	US
Telephone Number	:	321-299-7687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 EMERSON DR SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4972
Country	:	US
Telephone Number	:	321-299-7687
Fax Number	:

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

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	04/08/2009

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Directions to “ MRS. CORALIE PRINCE RN” Practice Location

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