MEDICARE: MS. WANDA ELLEN DELUIGI R.N.

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	163W00000X	Registered Nurse	RN854532	FL

General Provider Information

NPI Number	:	1689882623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA ELLEN DELUIGI R.N.

Provider Business Mailing Address
First Line	:	1343 COSTA MESA DR
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-6787
Country	:	US
Telephone Number	:	813-907-8389
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 OAK FAIR BLVD
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33610-7364
Country	:	US
Telephone Number	:	813-740-4262
Fax Number	:

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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