Healthcare Provider Details

I. General information

NPI: 1659008852
Provider Name (Legal Business Name): KATHERINE ADRIANA FALTOT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

57 GARRISON DR
JACKSON TN
38305-3173
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax:
Mailing address:
  • Phone: 202-957-9578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3272
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number243896
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11022068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: