Provider Demographics
NPI:1700209343
Name:GULF COAST NURSE REGISTER, LLC
Entity Type:Organization
Organization Name:GULF COAST NURSE REGISTER, LLC
Other - Org Name:VALUE CARE AT HOME TAMPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-514-2600
Mailing Address - Street 1:1753 W FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-1820
Mailing Address - Country:US
Mailing Address - Phone:813-514-2600
Mailing Address - Fax:813-514-2500
Practice Address - Street 1:1753 W FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-1820
Practice Address - Country:US
Practice Address - Phone:813-514-2600
Practice Address - Fax:813-514-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211667251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health