Healthcare Provider Details

I. General information

NPI: 1093627481
Provider Name (Legal Business Name): RADIANT CARE NURSE REGISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 PALM BEACH LAKES BLVD STE 1200
WEST PALM BEACH FL
33401-2214
US

IV. Provider business mailing address

4035 PALM BAY CIR APT A
WEST PALM BEACH FL
33406-4082
US

V. Phone/Fax

Practice location:
  • Phone: 561-385-5705
  • Fax:
Mailing address:
  • Phone: 561-385-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSANA BORREGO IGLESIAS
Title or Position: MANAGER
Credential: RN
Phone: 561-385-5705