Healthcare Provider Details

I. General information

NPI: 1619916152
Provider Name (Legal Business Name): ALAN W AMBROSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8066 124TH ST
SEMINOLE FL
33772-4419
US

IV. Provider business mailing address

8066 124TH ST
SEMINOLE FL
33772-4419
US

V. Phone/Fax

Practice location:
  • Phone: 215-346-6452
  • Fax:
Mailing address:
  • Phone: 215-346-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9312316
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN342910L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: