MEDICARE: ANGEL CARE NURSING REGISTRY INC.

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	30211356	FL

General Provider Information

NPI Number	:	1063677805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL CARE NURSING REGISTRY INC.

Provider Business Mailing Address
First Line	:	7401 WILES RD STE 229
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-509-3806
Fax Number	:

Provider Business Practice Location Address
First Line	:	7401 WILES RD STE 229
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2036
Country	:	US
Telephone Number	:	954-509-3806
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CORETTA TOMBLING
Credential	:	NURSE
Telephone Number	:	954-479-6922

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	07/22/2008

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