Healthcare Provider Details

I. General information

NPI: 1295051597
Provider Name (Legal Business Name): KARA LANDOL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

PO BOX 817737
HOLLYWOOD FL
33081-1737
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4180
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9197503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: