MEDICARE: MS. JEANNE CORONADO RPSGT

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1942424601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANNE CORONADO RPSGT

Provider Business Mailing Address
First Line	:	1512 SEAGULL DR
Second Line	:	APT #308
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2447
Country	:	US
Telephone Number	:	727-251-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 SEAGULL DR
Second Line	:	APT #308
City	:	PALM HARBOR
State	:	FL
Zip	:	34685
Country	:	US
Telephone Number	:	727-251-1025
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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