=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629477955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1ST NURSE REGISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2014
-----------------------------------------------------
Last Update Date | 09/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 N MILITARY TRL STE O
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-948-2010
-----------------------------------------------------
Fax | 561-948-2012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 N MILITARY TRL STE O
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-2901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-948-2010
-----------------------------------------------------
Fax | 561-948-2012
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JENNIFER LESLIE
-----------------------------------------------------
Credential | R.N., J.D.
-----------------------------------------------------
Telephone | 561-948-2010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 30211732
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------