Healthcare Provider Details

I. General information

NPI: 1619219755
Provider Name (Legal Business Name): RANATA LATISE SIMMONS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 SW 12TH AVE
DEERFIELD BEACH FL
33442-3108
US

IV. Provider business mailing address

1801 SW 119TH TER
MIRAMAR FL
33025-5634
US

V. Phone/Fax

Practice location:
  • Phone: 954-426-1169
  • Fax:
Mailing address:
  • Phone: 954-655-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9204900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: