Healthcare Provider Details

I. General information

NPI: 1376527176
Provider Name (Legal Business Name): JUDY ANN SABLES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S SEACREST BLVD
BOYNTON BEACH FL
33435-7969
US

IV. Provider business mailing address

9370 LAKE PARK DR
GRAND BLANC MI
48439-8050
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-7733
  • Fax:
Mailing address:
  • Phone: 248-496-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9271226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704154597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: