Healthcare Provider Details

I. General information

NPI: 1174540199
Provider Name (Legal Business Name): CAROL LEE RYDEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 2ND ST E
BRADENTON FL
34208-1042
US

IV. Provider business mailing address

PO BOX 863295
ORLANDO FL
32886-3295
US

V. Phone/Fax

Practice location:
  • Phone: 941-746-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2701062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: