Healthcare Provider Details

I. General information

NPI: 1750948451
Provider Name (Legal Business Name): DANIELLE ALYSE MUNGOVAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3555
US

IV. Provider business mailing address

10120 CORRIENTE CT
PALMETTO FL
34221-2191
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-9000
  • Fax:
Mailing address:
  • Phone: 386-295-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11002453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: