Healthcare Provider Details

I. General information

NPI: 1760690556
Provider Name (Legal Business Name): SANDRA LYNN KRUG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA LYNN HARTFIELD

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 VERNA BETHANY RD
MYAKKA CITY FL
34251-2032
US

IV. Provider business mailing address

6204 VERNA BETHANY RD
MYAKKA CITY FL
34251-2032
US

V. Phone/Fax

Practice location:
  • Phone: 941-322-9405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9258876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR859714
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN106813
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: