Healthcare Provider Details

I. General information

NPI: 1114426715
Provider Name (Legal Business Name): ANDRENE REID CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW 42ND AVE
PLANTATION FL
33317-2835
US

IV. Provider business mailing address

7300 NW 1ST ST APT 103
PLANTATION FL
33317-2224
US

V. Phone/Fax

Practice location:
  • Phone: 954-260-8293
  • Fax:
Mailing address:
  • Phone: 954-260-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9345121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: