MEDICARE: MRS. CHARLOTTE MIKAN

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	376K00000X	Nurse's Aide	30211677	FL
2	372600000X	Adult Companion	30211677	FL
3	374U00000X	Home Health Aide	30211677	FL
4	376J00000X	Homemaker	30211677	FL

General Provider Information

NPI Number	:	1922437433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE MIKAN

Provider Business Mailing Address
First Line	:	4651 SALISBURY RD
Second Line	:	SUITE 449
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	904-418-7900
Fax Number	:	904-418-7901

Provider Business Practice Location Address
First Line	:	4651 SALISBURY RD
Second Line	:	SUITE 449
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6107
Country	:	US
Telephone Number	:	904-418-7900
Fax Number	:	904-418-7901

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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