Healthcare Provider Details

I. General information

NPI: 1578008132
Provider Name (Legal Business Name): OANH YVONNE GREEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 MAX LEGGETT PKWY
JACKSONVILLE FL
32218-7273
US

IV. Provider business mailing address

1473 CARPATHIAN DR
JACKSONVILLE FL
32218-7974
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-4195
  • Fax:
Mailing address:
  • Phone: 904-210-2499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9259065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: