Healthcare Provider Details

I. General information

NPI: 1003038647
Provider Name (Legal Business Name): KRISTA MARIE PEVERINI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTA MARIE BERNARD CRNA

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 S TAMIAMI TRL
SARASOTA FL
34239-5114
US

IV. Provider business mailing address

PO BOX 51383
SARASOTA FL
34232-0311
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-3480
  • Fax: 941-552-3485
Mailing address:
  • Phone: 803-873-6733
  • Fax: 941-296-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9284417
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: