Provider Demographics
NPI:1013788207
Name:FLORIDA STATE NURSE REGISTRY SOUTH LLC
Entity Type:Organization
Organization Name:FLORIDA STATE NURSE REGISTRY SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-744-4496
Mailing Address - Street 1:12200 MENTA ST STE 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7540
Mailing Address - Country:US
Mailing Address - Phone:352-261-6475
Mailing Address - Fax:
Practice Address - Street 1:12200 MENTA ST STE 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7540
Practice Address - Country:US
Practice Address - Phone:352-261-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care