Provider Demographics
NPI:1578279311
Name:PROVIDERS HEALTHCARE STAFFING LLC
Entity Type:Organization
Organization Name:PROVIDERS HEALTHCARE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-368-6451
Mailing Address - Street 1:22918 COLDRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAND O' LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639
Mailing Address - Country:US
Mailing Address - Phone:813-368-6451
Mailing Address - Fax:
Practice Address - Street 1:2641 STONEWOOD PARK LOOP
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638
Practice Address - Country:US
Practice Address - Phone:813-368-6451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty