MEDICARE: FIRST CHOICE 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

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	:	1679167050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE NURSE REGISTRY LLC

Provider Business Mailing Address
First Line	:	5121 EHRLICH RD STE 101F
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2015
Country	:	US
Telephone Number	:	813-493-3829
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 EHRLICH RD STE 101F
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-2015
Country	:	US
Telephone Number	:	813-493-3829
Fax Number	:

Authorized Official
Title or Position	:	CONSULTANT
Name	:	BERNARD O SPOONER
Credential	:	RN
Telephone Number	:	139-927-8678

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/25/2021

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