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General NPI Number Information
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NPI Number | 1255932851
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Entity Type | Organization
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Legal Business Name | FLORIDA STATE NURSE REGISTRY
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 290 CITRUS TOWER BLVD STE 229
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City | CLERMONT
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State | FL
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Zip | 34711-2786
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Country | US
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Telephone | 522-616-4753
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Fax |
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Provider Business Mailing Address
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Address Line | 7003 PRESIDENTS DR STE 800
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City | ORLANDO
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State | FL
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Zip | 32809-5530
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Country | US
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Telephone | 140-744-0287
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JEFFREY RIVERA
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Credential | RN
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Telephone | 140-744-0287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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