Provider Demographics
NPI:1972995504
Name:ADVANCE NURSE REGISTRY, LLC
Entity type:Organization
Organization Name:ADVANCE NURSE REGISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAYNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-892-1561
Mailing Address - Street 1:2817 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 200-B2
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1889
Mailing Address - Country:US
Mailing Address - Phone:888-832-8850
Mailing Address - Fax:
Practice Address - Street 1:2817 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 200-B2
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1889
Practice Address - Country:US
Practice Address - Phone:888-832-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211761251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211761OtherAHCA