Healthcare Provider Details

I. General information

NPI: 1730521071
Provider Name (Legal Business Name): LEILA L. AZARES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5340
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3384002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: