Provider Demographics
NPI:1770807059
Name:PROFESSIONAL NURSES REGISTRY
Entity type:Organization
Organization Name:PROFESSIONAL NURSES REGISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:IBTISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSTAFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-549-0022
Mailing Address - Street 1:875 SE 47TH TERR.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904
Mailing Address - Country:US
Mailing Address - Phone:239-549-0022
Mailing Address - Fax:239-549-1739
Practice Address - Street 1:875 SE 47TH TERR.
Practice Address - Street 2:SUITE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904
Practice Address - Country:US
Practice Address - Phone:239-549-0022
Practice Address - Fax:239-549-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNR3009-096251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care