Healthcare Provider Details
I. General information
NPI: 1134127814
Provider Name (Legal Business Name): ELSIA LEE KENNEDY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/07/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3101 SW 34TH AVE 905-446
OCALA FL
34474-7447
US
IV. Provider business mailing address
3101 SW 34TH AVE
OCALA FL
34474-7447
US
V. Phone/Fax
- Phone: 352-274-0603
- Fax:
- Phone: 352-274-0603
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 367500000X |
| Taxonomy | Certified Registered Nurse Anesthetist |
| License Number | ARNP1774372 |
| License Number State | FL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: