Healthcare Provider Details

I. General information

NPI: 1508932732
Provider Name (Legal Business Name): INNOVATIVE NURSING MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E CENTRAL PKWY SUITE 100
ALTAMONTE SPRINGS FL
32701-3402
US

IV. Provider business mailing address

499 E CENTRAL PKWY SUITE 100
ALTAMONTE SPRINGS FL
32701-3402
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-4895
  • Fax: 407-647-5580
Mailing address:
  • Phone: 407-647-4895
  • Fax: 407-647-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH 13650
License Number StateFL

VIII. Authorized Official

Name: KAREN VOLOSIN
Title or Position: OWNER
Credential:
Phone: 407-647-4895