Provider Demographics
NPI:1528017183
Name:NURSEMD AT HOME, LLC
Entity Type:Organization
Organization Name:NURSEMD AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:386-734-0121
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-0730
Mailing Address - Country:US
Mailing Address - Phone:386-734-0121
Mailing Address - Fax:386-734-0332
Practice Address - Street 1:112 E NEW YORK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5504
Practice Address - Country:US
Practice Address - Phone:386-734-0121
Practice Address - Fax:386-734-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6510363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8422Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER