Healthcare Provider Details

I. General information

NPI: 1700017464
Provider Name (Legal Business Name): ELIZABETH GARCIA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 N. HARRISON PARKWAY SUITE 200
SUNRISE FL
33323-2896
US

IV. Provider business mailing address

1614 N. HARRISON PARKWAY SUITE 200
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 800-437-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9233902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: