MEDICARE: MRS. JOELLE VANESSA ARCHIBAL RN-BSN

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	RN9477621	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	:	1942774971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOELLE VANESSA ARCHIBAL RN-BSN

Provider Business Mailing Address
First Line	:	PO BOX 541801
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33454-1801
Country	:	US
Telephone Number	:	561-530-9686
Fax Number	:

Provider Business Practice Location Address
First Line	:	4656 VILLAS SANTORINI DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-5098
Country	:	US
Telephone Number	:	561-530-9686
Fax Number	:

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

Provider Enumeration Date	:	01/12/2019
Last Update Date	:	01/12/2019

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