Healthcare Provider Details

I. General information

NPI: 1497926208
Provider Name (Legal Business Name): ANNA MI NEIRA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA MONTERO

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

IV. Provider business mailing address

PO BOX 95004
LAKELAND FL
33804-5004
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7000
  • Fax: 866-264-8519
Mailing address:
  • Phone: 863-680-7000
  • Fax: 863-680-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberANT3405502
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3405502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: