Healthcare Provider Details

I. General information

NPI: 1861380347
Provider Name (Legal Business Name): IRIS ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W SAMPLE RD
DEERFIELD BEACH FL
33064-3542
US

IV. Provider business mailing address

5 W SAMPLE RD
DEERFIELD BEACH FL
33064-3542
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1700
  • Fax: 954-782-0145
Mailing address:
  • Phone: 954-782-1700
  • Fax: 954-782-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH RAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-782-1700