MEDICARE: NURSE PRO HOME CARE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	RN45783	FL

General Provider Information

NPI Number	:	1194265322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE PRO HOME CARE SERVICE

Provider Business Mailing Address
First Line	:	4300 S JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-4110
Country	:	US
Telephone Number	:	404-490-7545
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 S JOG RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-4110
Country	:	US
Telephone Number	:	404-490-7545
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER/R.N
Name	:	TERESA L MORTON
Credential	:	REGISTERED NURSE
Telephone Number	:	404-490-7545

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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