Provider Demographics
NPI:1508932732
Name:INNOVATIVE NURSING MANAGEMENT, INC
Entity Type:Organization
Organization Name:INNOVATIVE NURSING MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-647-4895
Mailing Address - Street 1:499 E CENTRAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3402
Mailing Address - Country:US
Mailing Address - Phone:407-647-4895
Mailing Address - Fax:407-647-5580
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-647-4895
Practice Address - Fax:407-647-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH 136503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1078042OtherNABP
FL103421900Medicaid
FL103421900Medicaid
FL1044610001Medicare NSC