Healthcare Provider Details

I. General information

NPI: 1174894174
Provider Name (Legal Business Name): RAGINI PILLAY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 HERSCHEL ST
JACKSONVILLE FL
32204-3819
US

IV. Provider business mailing address

12291 CAPTIVA BLUFF RD
JACKSONVILLE FL
32226-2061
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4030
  • Fax: 904-381-9808
Mailing address:
  • Phone: 904-705-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9209031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: