Provider Demographics
NPI:1558414649
Name:SELF EXPRESSIONS NURSING SUPPLIES, INC
Entity Type:Organization
Organization Name:SELF EXPRESSIONS NURSING SUPPLIES, INC
Other - Org Name:SELF EXPRESSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SELF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-651-4500
Mailing Address - Street 1:1 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1023
Mailing Address - Country:US
Mailing Address - Phone:850-651-4500
Mailing Address - Fax:850-651-4504
Practice Address - Street 1:1 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1023
Practice Address - Country:US
Practice Address - Phone:850-651-4500
Practice Address - Fax:850-651-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL260000400952332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies