MEDICARE: MS. MARTHA CECILIA SMALL

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	163WH0200X	Home Health Registered Nurse	RN2579852	FL

General Provider Information

NPI Number	:	1932142403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA CECILIA SMALL

Provider Business Mailing Address
First Line	:	7151 HARDING ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3827
Country	:	US
Telephone Number	:	954-297-1189
Fax Number	:	954-987-1135

Provider Business Practice Location Address
First Line	:	7151 HARDING ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3827
Country	:	US
Telephone Number	:	954-297-1189
Fax Number	:	954-987-1135

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/21/2022

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