MEDICARE: ADRIA DUNCAN

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629443858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIA DUNCAN

Provider Business Mailing Address
First Line	:	3351 NIGHTHAWK LN
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32506-9670
Country	:	US
Telephone Number	:	651-895-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 LAKE HOLLINGSWORTH DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5607
Country	:	US
Telephone Number	:	863-680-4263
Fax Number	:

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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