MEDICARE: ANDREW ROSENBLUM

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	390200000X	Student in an Organized Health Care Education/Training Program	PSI39132	FL

General Provider Information

NPI Number	:	1912466681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW ROSENBLUM

Provider Business Mailing Address
First Line	:	2121 COLLIER PKWY
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-5286
Country	:	US
Telephone Number	:	813-948-9819
Fax Number	:

Provider Business Practice Location Address
First Line	:	17347 EMERALD CHASE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3516
Country	:	US
Telephone Number	:	813-731-1906
Fax Number	:

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

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	03/13/2019

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