Healthcare Provider Details

I. General information

NPI: 1952538175
Provider Name (Legal Business Name): WILLIAM VONLUBBE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 STERTHAUS AVE
ORMOND BEACH FL
32174-5131
US

IV. Provider business mailing address

1613 HARRISON PKWY SUITE 200
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-6000
  • Fax: 954-514-3960
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-514-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9291052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: