Healthcare Provider Details

I. General information

NPI: 1356346811
Provider Name (Legal Business Name): JEFFREY ALAN ROSENKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 S FEDERAL HWY
BOYNTON BEACH FL
33435-6003
US

IV. Provider business mailing address

1495 S FEDERAL HWY
BOYNTON BEACH FL
33435-6003
US

V. Phone/Fax

Practice location:
  • Phone: 407-670-9765
  • Fax:
Mailing address:
  • Phone: 407-670-9765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: