Healthcare Provider Details

I. General information

NPI: 1992877294
Provider Name (Legal Business Name): JENNIFER M AINSWORTH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER M RAY

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

IV. Provider business mailing address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-7042
  • Fax: 850-474-9060
Mailing address:
  • Phone: 850-477-7042
  • Fax: 850-474-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-092761
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9244135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: