MEDICARE: HARRY BORCHERDING ARNP PA

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	314000000X	Skilled Nursing Facility	ARNP 9235683	FL

General Provider Information

NPI Number	:	1659539641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY BORCHERDING ARNP PA

Provider Business Mailing Address
First Line	:	1401 RIVERPLACE BLVD
Second Line	:	#910
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 RIVERPLACE BLVD
Second Line	:	#910
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-9069
Country	:	US
Telephone Number	:	352-514-2595
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HARRY BORCHERDING
Credential	:	ARNP
Telephone Number	:	352-514-2595

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	10/07/2008

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