Healthcare Provider Details

I. General information

NPI: 1275576100
Provider Name (Legal Business Name): KIMBERLY ANN HAYES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD
NAPLES FL
34119-3900
US

IV. Provider business mailing address

14734 INDIGO LAKES CIR
NAPLES FL
34119-4824
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-4862
  • Fax:
Mailing address:
  • Phone: 239-455-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9236648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: