MEDICARE: MS. JOLENE BERTLOFF MLIS, EIPA 3.6

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	171R00000X	Interpreter

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	171R00000X	OTHER	FL	INTERPRETER FOR DEAF

General Provider Information

NPI Number	:	1720410863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOLENE BERTLOFF MLIS, EIPA 3.6

Provider Business Mailing Address
First Line	:	1007 E HENRY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-6823
Country	:	US
Telephone Number	:	813-237-4353
Fax Number	:	813-237-4353

Provider Business Practice Location Address
First Line	:	1007 E HENRY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-6823
Country	:	US
Telephone Number	:	813-237-4353
Fax Number	:	813-237-4353

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

Provider Enumeration Date	:	07/31/2013
Last Update Date	:	07/31/2013

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