MEDICARE: ENVISTA HEALTH, L.L.C.

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	251J00000X	Nursing Care Agency		FL
2	251B00000X	Case Management Agency	30211638	FL
3	253Z00000X	In Home Supportive Care Agency		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
2	30211638	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1952644189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISTA HEALTH, L.L.C.

Provider Business Mailing Address
First Line	:	1810 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1645
Country	:	US
Telephone Number	:	813-252-2224
Fax Number	:	813-925-6924

Provider Business Practice Location Address
First Line	:	1810 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1645
Country	:	US
Telephone Number	:	813-252-2224
Fax Number	:	813-925-6924

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CHERYL HAMILTON
Credential	:
Telephone Number	:	813-252-2224

Provider Enumeration Date	:	04/06/2013
Last Update Date	:	10/31/2014

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