MEDICARE: HATTIE RUNZHEIMER

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	363LA2100X	Acute Care Nurse Practitioner	11004897	FL

General Provider Information

NPI Number	:	1598396269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HATTIE RUNZHEIMER

Provider Business Mailing Address
First Line	:	847 TYLER ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-1326
Country	:	US
Telephone Number	:	309-242-3053
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 TYLER ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-1326
Country	:	US
Telephone Number	:	309-242-3053
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ HATTIE RUNZHEIMER ” Practice Location

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