Healthcare Provider Details

I. General information

NPI: 1508364522
Provider Name (Legal Business Name): AMY YVONNE ENGELHARDT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3499
US

IV. Provider business mailing address

10729 DENALI DR
CLERMONT FL
34711-9127
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1000
  • Fax:
Mailing address:
  • Phone: 321-266-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9326930
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: