Healthcare Provider Details

I. General information

NPI: 1164414967
Provider Name (Legal Business Name): KAREN SEKOSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 WATERCOLOR WAY SUITE 355
SANTA ROSA BEACH FL
32459-7350
US

IV. Provider business mailing address

174 WATERCOLOR WAY SUITE 355
SANTA ROSA BEACH FL
32459
US

V. Phone/Fax

Practice location:
  • Phone: 904-469-0131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN311077L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number82711
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN223
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9164074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: