Provider Demographics
NPI:1255932851
Name:FLORIDA STATE NURSE REGISTRY
Entity type:Organization
Organization Name:FLORIDA STATE NURSE REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:140-744-0287
Mailing Address - Street 1:7003 PRESIDENTS DR STE 800
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5530
Mailing Address - Country:US
Mailing Address - Phone:140-744-0287
Mailing Address - Fax:
Practice Address - Street 1:290 CITRUS TOWER BLVD STE 229
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2786
Practice Address - Country:US
Practice Address - Phone:522-616-4753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE