MEDICARE: NELLYS ESTANGA RN, BSN

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	RN9301615	FL

General Provider Information

NPI Number	:	1790143493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLYS ESTANGA RN, BSN

Provider Business Mailing Address
First Line	:	180 E FOREST PARK DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4643
Country	:	US
Telephone Number	:	954-618-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 E FOREST PARK DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4643
Country	:	US
Telephone Number	:	954-618-8200
Fax Number	:

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

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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