Healthcare Provider Details

I. General information

NPI: 1316369044
Provider Name (Legal Business Name): SIGNATURE STAFF SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 CROWN POINT RD STE F
JACKSONVILLE FL
32257-7553
US

IV. Provider business mailing address

138 PALM COAST PKWY NE # 258
PALM COAST FL
32137-8241
US

V. Phone/Fax

Practice location:
  • Phone: 904-679-1819
  • Fax: 904-647-8096
Mailing address:
  • Phone: 904-679-1819
  • Fax: 904-647-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1585
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number1585
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1585
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1585
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1585
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1585
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1585
License Number StateFL

VIII. Authorized Official

Name: MATANA MANOMAT
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-679-1819