MEDICARE: LIZ JENIFFER ROLON

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1558055376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZ JENIFFER ROLON

Provider Business Mailing Address
First Line	:	211 LILY PAD RD
Second Line	:
City	:	EAGLE LAKE
State	:	FL
Zip	:	33839-5149
Country	:	US
Telephone Number	:	407-627-5920
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 LILY PAD RD
Second Line	:
City	:	EAGLE LAKE
State	:	FL
Zip	:	33839-5149
Country	:	US
Telephone Number	:	407-627-5920
Fax Number	:

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

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	06/05/2023

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