Healthcare Provider Details

I. General information

NPI: 1598178212
Provider Name (Legal Business Name): EMILY RUTH ALLARD-FONTANAROSA C.R.N.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

431 JUPITER LAKES BLVD APT 2102B
JUPITER FL
33458-7116
US

V. Phone/Fax

Practice location:
  • Phone: 561-744-4477
  • Fax: 561-263-5788
Mailing address:
  • Phone: 561-222-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9264186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: