MEDICARE: DEREK M MAKOWSKI RN

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	RN9356373	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN11019836	FL

General Provider Information

NPI Number	:	1861020562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK M MAKOWSKI RN

Provider Business Mailing Address
First Line	:	6434 CAVA ALTA DR UNIT 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6434 CAVA ALTA DR UNIT 105
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3221
Country	:	US
Telephone Number	:	727-674-3532
Fax Number	:

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

Provider Enumeration Date	:	03/29/2020
Last Update Date	:	06/06/2022

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