Healthcare Provider Details

I. General information

NPI: 1700870391
Provider Name (Legal Business Name): LADDEN D HERRMANN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SE 46TH ST
OCALA FL
34480-4716
US

IV. Provider business mailing address

1304 SE 46TH ST
OCALA FL
34480-4716
US

V. Phone/Fax

Practice location:
  • Phone: 352-216-8639
  • Fax: 352-873-9726
Mailing address:
  • Phone: 352-216-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9217228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: