Provider Demographics
NPI:1790156198
Name:SPECIALTY NURSING CORPS. INC.
Entity Type:Organization
Organization Name:SPECIALTY NURSING CORPS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-677-4700
Mailing Address - Street 1:10011 WATER WORKS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5304
Mailing Address - Country:US
Mailing Address - Phone:813-677-4700
Mailing Address - Fax:813-425-9774
Practice Address - Street 1:10011 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5304
Practice Address - Country:US
Practice Address - Phone:813-677-4700
Practice Address - Fax:813-425-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211422251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion