Basic Information
| Provider Information | |||||||||
| NPI: | 1821638289 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALING HANDS NURSING HOME SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26307 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336236307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523452237 | ||||||||
| FaxNumber: | 3526062857 | ||||||||
| Practice Location | |||||||||
| Address1: | 12170 CORTEZ BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523974292 | ||||||||
| FaxNumber: | 3523974298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2020 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAIG | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | FATIMA | ||||||||
| AuthorizedOfficialTitleorPosition: | APRN | ||||||||
| AuthorizedOfficialTelephone: | 3523452237 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | APRN | ||||||||
| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4LCDB | 01 | FL | FL BCBS | OTHER |