MEDICARE: PAUL BIGENHO APRN

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	APRN11024367	FL

General Provider Information

NPI Number	:	1881390284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BIGENHO APRN

Provider Business Mailing Address
First Line	:	2 MARSH RIDGE WATCH
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-2411
Country	:	US
Telephone Number	:	305-951-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 W GRANADA BLVD FL 2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5915
Country	:	US
Telephone Number	:	386-672-1023
Fax Number	:	386-263-2996

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

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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