MEDICARE: LEGS LLC

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	363LF0000X	Family Nurse Practitioner	ARNP9163789	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	:	1578011987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEGS LLC

Provider Business Mailing Address
First Line	:	1964 HOWELL BRANCH RD
Second Line	:	SUITE 100
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1042
Country	:	US
Telephone Number	:	407-276-7326
Fax Number	:	407-264-8261

Provider Business Practice Location Address
First Line	:	1964 HOWELL BRANCH RD
Second Line	:	SUITE 100
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1042
Country	:	US
Telephone Number	:	407-276-7326
Fax Number	:	407-264-8261

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	REBECCA KAY BRILL
Credential	:
Telephone Number	:	407-276-7326

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	04/03/2017

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Directions to “LEGS LLC ” Practice Location

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