MEDICARE: PAULA CAROL PALMER

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	163WE0003X	Emergency Registered Nurse	RN2957452	FL
2	163W00000X	Registered Nurse	RN2957452	FL

General Provider Information

NPI Number	:	1629682133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA CAROL PALMER

Provider Business Mailing Address
First Line	:	3857 SW BIRLEY AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-0003
Country	:	US
Telephone Number	:	386-365-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	3857 SW BIRLEY AVE
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-0003
Country	:	US
Telephone Number	:	386-365-5682
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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Directions to “ PAULA CAROL PALMER ” Practice Location

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