MEDICARE: ALICE ZANDRA HAUGABOOK

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	251E00000X	Home Health Agency		FL

General Provider Information

NPI Number	:	1972057032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE ZANDRA HAUGABOOK

Provider Business Mailing Address
First Line	:	1405 CORONADO AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3633
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 CORONADO AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3633
Country	:	US
Telephone Number	:	772-208-9433
Fax Number	:

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

Provider Enumeration Date	:	08/06/2016
Last Update Date	:	08/06/2016

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