Healthcare Provider Details

I. General information

NPI: 1700988367
Provider Name (Legal Business Name): JEANNIE TARAZI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N STATE ROAD 7
ROYAL PALM BEACH FL
33411-3514
US

IV. Provider business mailing address

100 HOSPITAL DR
BENNINGTON VT
05201-5004
US

V. Phone/Fax

Practice location:
  • Phone: 561-792-7333
  • Fax:
Mailing address:
  • Phone: 802-447-4535
  • Fax: 802-447-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number101-0025491
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11001980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: