MEDICARE: MRS. CONCEPCION FORNARIS CABALLERO 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	363LA2200X	Adult Health Nurse Practitioner	11002534	FL
2	363LG0600X	Gerontology Nurse Practitioner	11002534	FL
3	363LP2300X	Primary Care Nurse Practitioner	11002534	FL

General Provider Information

NPI Number	:	1922666312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONCEPCION FORNARIS CABALLERO APRN

Provider Business Mailing Address
First Line	:	6351 ADAMS ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1749
Country	:	US
Telephone Number	:	954-638-6924
Fax Number	:

Provider Business Practice Location Address
First Line	:	6351 ADAMS ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-1749
Country	:	US
Telephone Number	:	954-638-6924
Fax Number	:

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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