MEDICARE: ROSEMARY URBAN-PENN ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP2992752	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31195	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1770543613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY URBAN-PENN ARNP

Provider Business Mailing Address
First Line	:	1255 37TH ST
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6550
Country	:	US
Telephone Number	:	772-569-3100
Fax Number	:	772-569-0217

Provider Business Practice Location Address
First Line	:	1255 37TH ST
Second Line	:	SUITE A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6550
Country	:	US
Telephone Number	:	772-569-3100
Fax Number	:	772-569-0217

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/11/2007

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