Healthcare Provider Details

I. General information

NPI: 1003453838
Provider Name (Legal Business Name): CHRISTINA ELANA CIBULA RN, SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

224 BACKWATER CT
NAPLES FL
34119-9706
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-4862
  • Fax:
Mailing address:
  • Phone: 239-595-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11007596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: