Healthcare Provider Details

I. General information

NPI: 1831698026
Provider Name (Legal Business Name): DORA VARGAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 FOREST HILL BLVD
WELLINGTON FL
33414-6103
US

IV. Provider business mailing address

2220 WINDCREST LAKE CIR
ORLANDO FL
32824-5666
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-8563
  • Fax:
Mailing address:
  • Phone: 803-504-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9471753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: