MEDICARE: MRS. PATRICIA CEASAR PITTS

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	171M00000X	Case Manager/Care Coordinator		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	:	1588147110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA CEASAR PITTS

Provider Business Mailing Address
First Line	:	PO BOX 77375
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-7375
Country	:	US
Telephone Number	:	904-465-3466
Fax Number	:	904-751-3750

Provider Business Practice Location Address
First Line	:	13764 CHIPPERFIELD LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-5832
Country	:	US
Telephone Number	:	904-465-3466
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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