MEDICARE: MRS. ELIZABETH MARIE CEBOUTE CNA

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	372600000X	Adult Companion	CNA173107	FL
2	374U00000X	Home Health Aide	CNA173107	FL
3	376K00000X	Nurse's Aide	CNA173107	FL

General Provider Information

NPI Number	:	1609189109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH MARIE CEBOUTE CNA

Provider Business Mailing Address
First Line	:	4251 SIGNAL HILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2629
Country	:	US
Telephone Number	:	321-805-0334
Fax Number	:	407-822-7786

Provider Business Practice Location Address
First Line	:	4251 SIGNAL HILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-2629
Country	:	US
Telephone Number	:	321-805-0334
Fax Number	:	407-822-7786

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

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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