MEDICARE: REBECCA EVELYN ESTRILL

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	164W00000X	Licensed Practical Nurse	PN5223728	FL

General Provider Information

NPI Number	:	1649788605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA EVELYN ESTRILL

Provider Business Mailing Address
First Line	:	3301 NW 36TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5317
Country	:	US
Telephone Number	:	954-300-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 SE 1ST AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2917
Country	:	US
Telephone Number	:	954-831-5859
Fax Number	:

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

Provider Enumeration Date	:	01/11/2018
Last Update Date	:	01/11/2018

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