Healthcare Provider Details

I. General information

NPI: 1699782706
Provider Name (Legal Business Name): NASSAU PEST MANAGEMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97056 CARPENTER RIDGE CT
YULEE FL
32097-5053
US

IV. Provider business mailing address

PO BOX 16475
FERNANDINA BEACH FL
32035-3125
US

V. Phone/Fax

Practice location:
  • Phone: 904-591-1522
  • Fax: 904-624-7095
Mailing address:
  • Phone: 904-591-1522
  • Fax: 904-624-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberJB5513
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN PHILLIP PROM
Title or Position: PRESIDENT
Credential:
Phone: 904-591-1522