MEDICARE: RENAE VAUGHN RN, MSN, ARNP-C

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	363L00000X	Nurse Practitioner	APRN9495960	FL
2	363LA2200X	Adult Health Nurse Practitioner	A3669	SC
3	363LA2200X	Adult Health Nurse Practitioner	APRN9495960	FL
4	363LA2200X	Adult Health Nurse Practitioner	4704167219	MI

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	:	1518923093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE VAUGHN RN, MSN, ARNP-C

Provider Business Mailing Address
First Line	:	PO BOX 102222
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-2222
Country	:	US
Telephone Number	:	239-274-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2812
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-586-1860
Fax Number	:	386-586-1861

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	10/28/2022

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