Healthcare Provider Details

I. General information

NPI: 1669910667
Provider Name (Legal Business Name): KRISTY LEE CARONIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EDENBERRY AVE
JUPITER FL
33458
US

IV. Provider business mailing address

175 EDENBERRY AVE
JUPITER FL
33458-6531
US

V. Phone/Fax

Practice location:
  • Phone: 631-335-7209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: