1972995504 NPI number — ADVANCE NURSE REGISTRY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972995504 NPI number — ADVANCE NURSE REGISTRY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE NURSE REGISTRY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972995504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 E OAKLAND PARK BLVD
Provider Second Line Business Mailing Address:
SUITE 200-B2
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33306-1889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-832-8850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 E OAKLAND PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 200-B2
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33306-1889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-832-8850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BINGHAM
Authorized Official First Name:
RAYNOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
954-892-1561

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  30211761 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 30211761 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30211761 . This is a "AHCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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