Healthcare Provider Details

I. General information

NPI: 1124228432
Provider Name (Legal Business Name): EILEEN O'HARA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

PO BOX 817737
HOLLYWOOD FL
33081-1737
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax:
Mailing address:
  • Phone: 800-437-2672
  • Fax: 954-851-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1877452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: