Healthcare Provider Details

I. General information

NPI: 1033185269
Provider Name (Legal Business Name): WANDA L. SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA LOU BOYD

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY #200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

44 BENTWATER CIR
BOYNTON BEACH FL
33426-7646
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax:
Mailing address:
  • Phone: 561-649-1932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3356972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: