Healthcare Provider Details

I. General information

NPI: 1639688211
Provider Name (Legal Business Name): MARY ELIZABETH LIGAD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH CAMPOLIETA RN

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

3105 N WOODROW AVE
TAMPA FL
33603-5510
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5551
  • Fax:
Mailing address:
  • Phone: 315-529-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9401414
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233461
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9401414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: