MEDICARE: KAREN MARIE MCCORMICK FDN-P

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1770310609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MARIE MCCORMICK FDN-P

Provider Business Mailing Address
First Line	:	1729 THEODORA LN APT 320
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8287
Country	:	US
Telephone Number	:	904-534-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 THEODORA LN APT 320
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-8287
Country	:	US
Telephone Number	:	904-534-8305
Fax Number	:

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

Provider Enumeration Date	:	09/16/2024
Last Update Date	:	09/22/2024

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