Healthcare Provider Details

I. General information

NPI: 1306193099
Provider Name (Legal Business Name): MILLICENT COHEN WHALEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MILLICENT SHEREE COHEN

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S ORANGE AVE SUITE 100
ORLANDO FL
32806-2944
US

IV. Provider business mailing address

PO BOX 191
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-7715
  • Fax: 407-650-7124
Mailing address:
  • Phone: 904-697-4127
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9347090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: