Basic Information
| Provider Information | |||||||||
| NPI: | 1154950038 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASSURANURSE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5030 78TH AVE N STE 11 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337812406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275464861 | ||||||||
| FaxNumber: | 8007138330 | ||||||||
| Practice Location | |||||||||
| Address1: | 5030 78TH AVE N STE 11 | ||||||||
| Address2: | |||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337812406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275464861 | ||||||||
| FaxNumber: | 8007138330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2020 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | GOMEZ REXACH | ||||||||
| AuthorizedOfficialFirstName: | ISAAC | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7275464861 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 251J00000X | N | Agencies | Nursing Care | 253Z00000X | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | 30212079 | 01 | FL | AHCA LICENSED NURSE REGISTRY | OTHER |