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General NPI Number Information
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NPI Number | 1174349625
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Entity Type | Organization
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Legal Business Name | NYSPYER2 SKILLED NURSING SERVICE LLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 5805 NW 27TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32653-1942
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Country | US
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Telephone | 352-246-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 NW 27TH ST
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City | GAINESVILLE
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State | FL
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Zip | 32653-1942
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Country | US
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Telephone | 352-246-5355
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | SHARON DENISE FORT
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Credential | PN997881
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Telephone | 352-246-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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