MEDICARE: ASPEN 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	:	1457934515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN NURSE REGISTRY LLC

Provider Business Mailing Address
First Line	:	1647 SUN CITY CENTER PLZ BLDG 201B
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5373
Country	:	US
Telephone Number	:	813-299-2148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1647 SUN CITY CENTER PLZ BLDG 201B
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5373
Country	:	US
Telephone Number	:	813-296-7339
Fax Number	:

Authorized Official
Title or Position	:	NURSE CONSULTANT
Name	:	BERNARD O SPOONER
Credential	:	RN
Telephone Number	:	813-296-7339

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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Directions to “ASPEN NURSE REGISTRY LLC ” Practice Location

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