Provider Demographics
NPI:1770215923
Name:NIGHTINGALE HEALTHCARE PSC
Entity Type:Organization
Organization Name:NIGHTINGALE HEALTHCARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:EASTON-HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-538-4208
Mailing Address - Street 1:210 N BROADWAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2212
Mailing Address - Country:US
Mailing Address - Phone:727-538-4208
Mailing Address - Fax:
Practice Address - Street 1:210 N BROADWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2212
Practice Address - Country:US
Practice Address - Phone:727-538-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty