MEDICARE: ANGELWINGS CARE NURSE REGISTRY LLC

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

General Provider Information

NPI Number	:	1265364012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELWINGS CARE NURSE REGISTRY LLC

Provider Business Mailing Address
First Line	:	5916 NW 56TH CIR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3526
Country	:	US
Telephone Number	:	954-766-0610
Fax Number	:	954-715-6116

Provider Business Practice Location Address
First Line	:	5916 NW 56TH CIR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3526
Country	:	US
Telephone Number	:	954-766-0610
Fax Number	:	954-715-6116

Authorized Official
Title or Position	:	OWNER
Name	:	DELORES HEADLEY
Credential	:
Telephone Number	:	954-638-5056

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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