Healthcare Provider Details

I. General information

NPI: 1063901783
Provider Name (Legal Business Name): KRISTA L. HAMM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WINDERLEY PL STE 115
MAITLAND FL
32751
US

IV. Provider business mailing address

500 WINDERLEY PL STE 115
MAITLAND FL
32751-7406
US

V. Phone/Fax

Practice location:
  • Phone: 407-581-9180
  • Fax: 865-560-7066
Mailing address:
  • Phone: 407-581-9180
  • Fax: 865-560-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9293770
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: