Healthcare Provider Details

I. General information

NPI: 1043735657
Provider Name (Legal Business Name): MARY ELIZABETH PLEWNIAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH OSBACH

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

3211 W SWANN AVE UNIT 1106
TAMPA FL
33609-5502
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone: 313-658-0099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberGAA-CRNA001343
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9400752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: