MEDICARE: GLYSEL MADRIGAL FNP

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	9228055	FL

General Provider Information

NPI Number	:	1598186355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLYSEL MADRIGAL FNP

Provider Business Mailing Address
First Line	:	904-590 BEVERLY ST.
Second Line	:
City	:	THUNDER BAY
State	:	ON
Zip	:	P7B6H1
Country	:	CA
Telephone Number	:	807-629-5177
Fax Number	:	807-683-7404

Provider Business Practice Location Address
First Line	:	7832 COLLINS AVE APT 407
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-2173
Country	:	US
Telephone Number	:	305-484-6191
Fax Number	:

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

Provider Enumeration Date	:	12/21/2013
Last Update Date	:	12/21/2013

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