MEDICARE: JANICE ELAINE ANDERSON RN

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	163W00000X	Registered Nurse	RN1974472	FL

General Provider Information

NPI Number	:	1619535341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE ELAINE ANDERSON RN

Provider Business Mailing Address
First Line	:	111 LAKE DR
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-4210
Country	:	US
Telephone Number	:	305-502-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 1ST ST N STE 200
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-6939
Country	:	US
Telephone Number	:	866-298-5038
Fax Number	:	888-794-5038

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

Provider Enumeration Date	:	05/29/2019
Last Update Date	:	05/29/2019

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