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NPI Code Detail

MEDICARE: NANDRA D. MANSARAM CRNA

MEDICARE: NANDRA D. MANSARAM CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN3201622FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588624605
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANDRA D. MANSARAM CRNA
Provider Business Mailing Address
First Line : PO BOX 744538
Second Line :
City : ATLANTA
State : GA
Zip : 30374-4538
Country : US
Telephone Number : 800-296-2611
Fax Number :
Provider Business Practice Location Address
First Line : 1600 S ANDREWS AVE
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33316-2510
Country : US
Telephone Number : 954-355-4400
Fax Number : 954-355-4797
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 02/16/2026

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Directions to “ NANDRA D. MANSARAM CRNA” Practice Location

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