MEDICARE: MS. MOLLIE R JERMAN ARNP

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	163W00000X	Registered Nurse	ARNP2190312	FL

General Provider Information

NPI Number	:	1922324821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLIE R JERMAN ARNP

Provider Business Mailing Address
First Line	:	760 S VILLAGE DR N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33716-3167
Country	:	US
Telephone Number	:	727-441-7454
Fax Number	:

Provider Business Practice Location Address
First Line	:	7615 LITTLE RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5525
Country	:	US
Telephone Number	:	727-845-8080
Fax Number	:

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

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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