MEDICARE: ALAIN PORTAL MENENDEZ 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	11021243	FL

General Provider Information

NPI Number	:	1891410353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAIN PORTAL MENENDEZ APRN

Provider Business Mailing Address
First Line	:	6803 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2842
Country	:	US
Telephone Number	:	786-616-3621
Fax Number	:

Provider Business Practice Location Address
First Line	:	6803 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-2842
Country	:	US
Telephone Number	:	786-616-3621
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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