MEDICARE: BRENDA L LEE

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	3747P1801X	Personal Care Attendant
2	3747P1801X	Personal Care Attendant		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	:	1982191326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA L LEE

Provider Business Mailing Address
First Line	:	95024 RAINTREE LN
Second Line	:
City	:	FERNANDINA
State	:	FL
Zip	:	32034-7105
Country	:	US
Telephone Number	:	904-557-8002
Fax Number	:	904-432-8115

Provider Business Practice Location Address
First Line	:	95024 RAINTREE LN
Second Line	:
City	:	FERNANDINA
State	:	FL
Zip	:	32034-7105
Country	:	US
Telephone Number	:	904-557-8002
Fax Number	:	904-432-8115

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

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	04/20/2018

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Directions to “ BRENDA L LEE ” Practice Location

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