Healthcare Provider Details

I. General information

NPI: 1629493143
Provider Name (Legal Business Name): ANGELA R ROMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33134-6914
US

IV. Provider business mailing address

5555 PONCE DE LEON BLVD
CORAL GABLES FL
33134-6914
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-0695
  • Fax:
Mailing address:
  • Phone: 305-689-0695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9252884
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9252884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: