Healthcare Provider Details

I. General information

NPI: 1467083857
Provider Name (Legal Business Name): LAURA IRENE CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11006010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: