MEDICARE: MS. CAROL BRZOZOWSKI ARNP

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	363LA2200X	Adult Health Nurse Practitioner	ARPN9216793	FL

General Provider Information

NPI Number	:	1962480020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL BRZOZOWSKI ARNP

Provider Business Mailing Address
First Line	:	5830 HERONVIEW CRESCENT DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-5890
Country	:	US
Telephone Number	:	813-957-8527
Fax Number	:	813-655-0197

Provider Business Practice Location Address
First Line	:	5830 HERONVIEW CRESCENT DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-5890
Country	:	US
Telephone Number	:	813-957-8527
Fax Number	:	813-655-0197

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

Provider Enumeration Date	:	01/08/2006
Last Update Date	:	07/08/2007

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