Healthcare Provider Details

I. General information

NPI: 1477250074
Provider Name (Legal Business Name): KEYS ISLAND NURSE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94825 OVERSEAS HWY UNIT 255
KEY LARGO FL
33037-3898
US

IV. Provider business mailing address

94825 OVERSEAS HWY UNIT 255
KEY LARGO FL
33037-3898
US

V. Phone/Fax

Practice location:
  • Phone: 786-647-8736
  • Fax:
Mailing address:
  • Phone: 786-647-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MAXI MARTINEZ
Title or Position: PRESIDENT
Credential: R.N.
Phone: 786-647-8736