Healthcare Provider Details

I. General information

NPI: 1568421816
Provider Name (Legal Business Name): LYNETTE M SONNTAG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE BROWARD GENERAL MEDICAL CENTER
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

3601 W COMMERCIAL BLVD ANESCO NORTH BROWARD
FORT LAUDERDALE FL
33309-3300
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-4400
  • Fax:
Mailing address:
  • Phone: 954-485-5666
  • Fax: 954-484-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1670492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: