Healthcare Provider Details

I. General information

NPI: 1306873013
Provider Name (Legal Business Name): CANDACE J. BROWN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE DEPARTMENT OF ANESTHESIA
MIAMI FL
33136-1003
US

IV. Provider business mailing address

PO BOX 816759
HOLLYWOOD FL
33081-0759
US

V. Phone/Fax

Practice location:
  • Phone: 305-325-5416
  • Fax: 954-964-6084
Mailing address:
  • Phone: 954-964-2450
  • Fax: 954-964-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 2875462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: