Healthcare Provider Details

I. General information

NPI: 1902180912
Provider Name (Legal Business Name): DAWN LIEBERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN CAKE

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DON WICKHAM DR
CLERMONT FL
34711
US

IV. Provider business mailing address

1381 CITRUS TOWER BLVD SUITE 104
CLERMONT FL
34711-1957
US

V. Phone/Fax

Practice location:
  • Phone: 352-243-9114
  • Fax: 352-243-7822
Mailing address:
  • Phone: 352-243-9114
  • Fax: 352-243-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9261107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: