MEDICARE: MRS. PRISCILLA M. RENWICK NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	R551635	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PRISCILLA M. RENWICK NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 1810
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39502-1810
Country	:	US
Telephone Number	:	228-863-4000
Fax Number	:	228-863-4003

Provider Business Practice Location Address
First Line	:	4333 15TH ST
Second Line	:	SUITE A
City	:	GULFPORT
State	:	MS
Zip	:	39501-2525
Country	:	US
Telephone Number	:	228-863-4000
Fax Number	:	228-863-4003

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/10/2014

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Directions to “ MRS. PRISCILLA M. RENWICK NURSE PRACTITIONER” Practice Location

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