Basic Information
| Provider Information | |||||||||
| NPI: | 1376853580 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NURSESPRING OF JACKSONVILLE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NURSEFINDERS OF JACKSONVILLE, LLC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9120 MIDLOTHIAN TNPK | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045609400 | ||||||||
| FaxNumber: | 8042728833 | ||||||||
| Practice Location | |||||||||
| Address1: | 10024 SAN JOSE BLVD. | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043460500 | ||||||||
| FaxNumber: | 9043460196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2010 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | JASON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8504798620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 003138400 | 05 | FL | MEDICAID |