Healthcare Provider Details

I. General information

NPI: 1720011281
Provider Name (Legal Business Name): RHONDA EDRALINE PICKARD C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W SAMPLE RD
POMPANO BEACH FL
33064-3542
US

IV. Provider business mailing address

11031 BAYBREEZE WAY
BOCA RATON FL
33428-1251
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1700
  • Fax:
Mailing address:
  • Phone: 561-212-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166881
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: