MEDICARE: PARNELL

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	302R00000X	Health Maintenance Organization	ARNP3361142	FL

General Provider Information

NPI Number	:	1962851899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARNELL

Provider Business Mailing Address
First Line	:	647 ORANGE AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	647 ORANGE AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-6731
Country	:	US
Telephone Number	:	386-916-9488
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	JOHN PARNELL
Credential	:
Telephone Number	:	386-916-9488

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	06/10/2016

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Directions to “PARNELL ” Practice Location

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