Healthcare Provider Details

I. General information

NPI: 1154732956
Provider Name (Legal Business Name): JESSICA LLANOS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1119
US

IV. Provider business mailing address

28166 ISLET TRL
BONITA SPRINGS FL
34135-8507
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6490
  • Fax:
Mailing address:
  • Phone: 617-834-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN269247
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9415835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: