MEDICARE: NANCY PAULINE

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	310400000X	Assisted Living Facility	AL8056	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932484573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANCY PAULINE

Provider Business Mailing Address
First Line	:	6003 AMBASSADOR DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3435
Country	:	US
Telephone Number	:	813-886-0481
Fax Number	:	813-925-3825

Provider Business Practice Location Address
First Line	:	6003 AMBASSADOR DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3435
Country	:	US
Telephone Number	:	813-886-0481
Fax Number	:	813-925-3825

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROBERT A LOOMIS
Credential	:
Telephone Number	:	813-855-7241

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	10/14/2011

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Directions to “NANCY PAULINE ” Practice Location

Language	Start Address	Practice Location

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