Healthcare Provider Details

I. General information

NPI: 1639191042
Provider Name (Legal Business Name): VICTORIA B HERRING CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 LPGA BLVD SUITE 210
DAYTONA BEACH FL
32117-7130
US

IV. Provider business mailing address

5931 RIVERSIDE DR
PORT ORANGE FL
32127-6445
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-1744
  • Fax: 386-274-1644
Mailing address:
  • Phone: 386-304-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP972052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: