Healthcare Provider Details

I. General information

NPI: 1376846485
Provider Name (Legal Business Name): NICOLE THERESE CEJA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 02/07/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6043 WINTHROP COMMERCE AVE
RIVERVIEW FL
33578-4272
US

IV. Provider business mailing address

5606 SKIMMER DR
APOLLO BEACH FL
33572-3354
US

V. Phone/Fax

Practice location:
  • Phone: 813-699-1200
  • Fax:
Mailing address:
  • Phone: 401-474-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number36618
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4391
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9433127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: