Healthcare Provider Details

I. General information

NPI: 1811945702
Provider Name (Legal Business Name): RIVERCHASE ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 CROSS POINT DR #2
NAPLES FL
34110
US

IV. Provider business mailing address

6860 HUNTINGTON LAKES CIR APT 102
NAPLES FL
34119-8022
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-5748
  • Fax:
Mailing address:
  • Phone: 239-514-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JUDITH A HAYDEN
Title or Position: OWNER
Credential: CRNA
Phone: 239-514-1310