Healthcare Provider Details

I. General information

NPI: 1720444623
Provider Name (Legal Business Name): KATRINA CANADY A.R.N.P., C.R.N.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13609 DEVAN LEE DR E
JACKSONVILLE FL
32226-5810
US

IV. Provider business mailing address

13609 DEVAN LEE DR E
JACKSONVILLE FL
32226-5810
US

V. Phone/Fax

Practice location:
  • Phone: 904-400-3434
  • Fax:
Mailing address:
  • Phone: 904-400-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 3364102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: