Provider Demographics
NPI:1265699524
Name:SOUTHERN OCEAN REGISTERED NURSE FIRST ASSISTANT (RNFA),LLC
Entity type:Organization
Organization Name:SOUTHERN OCEAN REGISTERED NURSE FIRST ASSISTANT (RNFA),LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP/C;RNFA
Authorized Official - Phone:609-597-4603
Mailing Address - Street 1:201 PETER RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3659
Mailing Address - Country:US
Mailing Address - Phone:609-597-4603
Mailing Address - Fax:
Practice Address - Street 1:201 PETER RD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3659
Practice Address - Country:US
Practice Address - Phone:609-597-4603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00009800363LA2200X
FLARNP2016122363LA2200X
NJ26N005034800163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054778ATWOtherMEDICARE ID-TYPE UNSPECIFIED
NJ0046655Medicaid
NJ054778SDTNMedicare PIN
NJP55853Medicare UPIN