MEDICARE: ARCILIA JUDITH GARCIA LPN

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1912501628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARCILIA JUDITH GARCIA LPN

Provider Business Mailing Address
First Line	:	3425 BAYSIDE LAKES BLVD SE # 223
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6867
Country	:	US
Telephone Number	:	321-989-9409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 ANDRUS AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6632
Country	:	US
Telephone Number	:	321-989-9409
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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