Healthcare Provider Details

I. General information

NPI: 1689706830
Provider Name (Legal Business Name): MARK HERT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N FLAGLER DR
WEST PALM BEACH FL
33407-6109
US

IV. Provider business mailing address

2001 N FLAGLER DR
WEST PALM BEACH FL
33407-6109
US

V. Phone/Fax

Practice location:
  • Phone: 561-721-8755
  • Fax: 561-340-1095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9201844
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: