1376853580 NPI number — NURSESPRING OF JACKSONVILLE, LLC

Table of content: (NPI 1376853580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376853580 NPI number — NURSESPRING OF JACKSONVILLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NURSESPRING OF JACKSONVILLE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NURSEFINDERS OF JACKSONVILLE, LLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376853580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9120 MIDLOTHIAN TNPK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-560-9400
Provider Business Mailing Address Fax Number:
804-272-8833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10024 SAN JOSE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-346-0500
Provider Business Practice Location Address Fax Number:
904-346-0196
Provider Enumeration Date:
10/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JASON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
850-479-8620

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003138400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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