Healthcare Provider Details

I. General information

NPI: 1902058100
Provider Name (Legal Business Name): JACQUELINE SONJA LIBERMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8375 NW 53RD ST
DORAL FL
33166-4611
US

IV. Provider business mailing address

8375 NW 53RD ST
DORAL FL
33166-4611
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-8375
  • Fax:
Mailing address:
  • Phone: 305-689-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9278172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: