MEDICARE: ELDAKA PATRICE ADMORE

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	374U00000X	Home Health Aide
2	376J00000X	Homemaker
3	376K00000X	Nurse's Aide	CNA173993	FL

General Provider Information

NPI Number	:	1780971309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELDAKA PATRICE ADMORE

Provider Business Mailing Address
First Line	:	1833 PAULINE DR
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-6304
Country	:	US
Telephone Number	:	863-585-1366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1833 PAULINE DR
Second Line	:
City	:	LAKE ALFRED
State	:	FL
Zip	:	33850-6304
Country	:	US
Telephone Number	:	863-585-1366
Fax Number	:

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

Provider Enumeration Date	:	07/03/2011
Last Update Date	:	07/03/2011

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