MEDICARE: MS. CARLA SIMONE HOSKINS LICENSED NURSE

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	PN1124561	FL

General Provider Information

NPI Number	:	1679711154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA SIMONE HOSKINS LICENSED NURSE

Provider Business Mailing Address
First Line	:	5307 REGAL OAK CIRCLE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810
Country	:	US
Telephone Number	:	407-292-9136
Fax Number	:	407-292-9136

Provider Business Practice Location Address
First Line	:	5307 REGAL OAK CIRCLE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810
Country	:	US
Telephone Number	:	407-292-9136
Fax Number	:	407-292-9136

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

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	01/22/2009

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