Healthcare Provider Details

I. General information

NPI: 1679072789
Provider Name (Legal Business Name): NADINE DAVIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

13880 NE 13TH AVE
NORTH MIAMI FL
33161-3411
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9282763
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9282763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: