Healthcare Provider Details

I. General information

NPI: 1023083847
Provider Name (Legal Business Name): DENISE SHARON MCCLURE-DRABICK CRNA, ARNP,BA ,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 03/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 LAKE PARK DR
FERNANDINA BEACH FL
32034-1942
US

IV. Provider business mailing address

1709 LAKE PARK DR
FERNANDINA BEACH FL
32034-1942
US

V. Phone/Fax

Practice location:
  • Phone: 904-557-8101
  • Fax:
Mailing address:
  • Phone: 904-321-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-118994 NA-03139
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number213978
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209729
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9187995
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201042814
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number178000
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-790152/CRNA-4035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: