Healthcare Provider Details

I. General information

NPI: 1437560935
Provider Name (Legal Business Name): GRACE ELARO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 US HIGHWAY 301 S
RIVERVIEW FL
33578-6300
US

IV. Provider business mailing address

1901 ULMERTON RD SUITE 450
CLEARWATER FL
33762-2300
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-0000
  • Fax: 656-233-5024
Mailing address:
  • Phone: 727-573-7777
  • Fax: 727-573-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9190632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: