Healthcare Provider Details

I. General information

NPI: 1255447223
Provider Name (Legal Business Name): BAMBI LYNN DURIK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E MELBOURNE AVE
MELBOURNE FL
32901-5578
US

IV. Provider business mailing address

909 E MELBOURNE AVE
MELBOURNE FL
32901-5578
US

V. Phone/Fax

Practice location:
  • Phone: 321-704-2544
  • Fax:
Mailing address:
  • Phone: 321-704-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9300056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: