Healthcare Provider Details

I. General information

NPI: 1902871270
Provider Name (Legal Business Name): NANCY ELIZABETH PORTER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684B MIDWAY DR
OCALA FL
34472-8542
US

IV. Provider business mailing address

684B MIDWAY DR
OCALA FL
34472-8542
US

V. Phone/Fax

Practice location:
  • Phone: 352-680-0385
  • Fax:
Mailing address:
  • Phone: 352-680-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP2523642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: