Healthcare Provider Details

I. General information

NPI: 1811908486
Provider Name (Legal Business Name): BARBARA MOGER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 LYNNDALE RD
FERNANDINA BEACH FL
32034-5201
US

IV. Provider business mailing address

2416 LYNNDALE RD
FERNANDINA BEACH FL
32034-5201
US

V. Phone/Fax

Practice location:
  • Phone: 904-775-5280
  • Fax: 904-775-5281
Mailing address:
  • Phone: 904-775-5280
  • Fax: 904-775-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11010386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: