Healthcare Provider Details

I. General information

NPI: 1669930236
Provider Name (Legal Business Name): DANIELLE LUCIENNE LEBLANC CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 TECH DATA DR STE 101
CLEARWATER FL
33760-3122
US

IV. Provider business mailing address

7577 SW 87TH TER
GAINESVILLE FL
32608-8763
US

V. Phone/Fax

Practice location:
  • Phone: 727-573-7777
  • Fax:
Mailing address:
  • Phone: 352-872-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9368714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: