Healthcare Provider Details

I. General information

NPI: 1073843314
Provider Name (Legal Business Name): PAMELA CHRISTINA VANVLIET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

5424 GRAND BLVD
NEW PORT RICHEY FL
34652-4008
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-2929
  • Fax:
Mailing address:
  • Phone: 727-845-1736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberANT2623062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: