Provider Demographics
NPI:1164522215
Name:NURSECORE MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:NURSECORE MANAGEMENT SERVICES LLC
Other - Org Name:NURSECORE OF ST PETERSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-649-1166
Mailing Address - Street 1:PO BOX 201925
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-1925
Mailing Address - Country:US
Mailing Address - Phone:817-649-1166
Mailing Address - Fax:817-649-2638
Practice Address - Street 1:1919 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-4841
Practice Address - Country:US
Practice Address - Phone:727-345-7009
Practice Address - Fax:727-345-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20790095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH0WOtherBLUE CROSS BLUE SHIELD
FL115054200Medicaid