Healthcare Provider Details

I. General information

NPI: 1750040119
Provider Name (Legal Business Name): NURSETEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6108 OLD HICKORY RD
CRESTVIEW FL
32539-7172
US

IV. Provider business mailing address

PO BOX 590
MOBILE AL
36601-0590
US

V. Phone/Fax

Practice location:
  • Phone: 850-252-4312
  • Fax:
Mailing address:
  • Phone: 850-252-4312
  • Fax: 850-361-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SHELIA WHITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-252-4312