Healthcare Provider Details

I. General information

NPI: 1679986889
Provider Name (Legal Business Name): MORGAN OLIVIA VIDAL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

92 W MILLER ST
ORLANDO FL
32806-2032
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2022
  • Fax: 321-843-2152
Mailing address:
  • Phone: 321-841-2022
  • Fax: 321-843-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9379776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: