Healthcare Provider Details

I. General information

NPI: 1093822405
Provider Name (Legal Business Name): VICTORIA LEE COYNE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 W. NEWBERRY ROAD SUITE 302
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6400 W. NEWBERRY ROAD SUITE 302
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-8902
  • Fax: 352-224-1094
Mailing address:
  • Phone: 352-331-8902
  • Fax: 352-224-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1546722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: