Healthcare Provider Details

I. General information

NPI: 1659416402
Provider Name (Legal Business Name): CRISTA SNOOK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 W FOREST HILL BLVD STE 182
WELLINGTON FL
33414-5700
US

IV. Provider business mailing address

12230 W FOREST HILL BLVD STE 182
WELLINGTON FL
33414-5700
US

V. Phone/Fax

Practice location:
  • Phone: 800-394-4445
  • Fax: 706-434-8906
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-434-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberANT2684092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: