Healthcare Provider Details

I. General information

NPI: 1407827421
Provider Name (Legal Business Name): AMY JEAN BORDEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11161 HEALTH PARK BLVD
NAPLES FL
34110-5730
US

IV. Provider business mailing address

7740 HAVERHILL CT
NAPLES FL
34104-9483
US

V. Phone/Fax

Practice location:
  • Phone: 239-234-2620
  • Fax: 239-234-2622
Mailing address:
  • Phone: 239-877-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9221160
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9221160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: