Healthcare Provider Details

I. General information

NPI: 1821399494
Provider Name (Legal Business Name): JOHNNILYNN MASSUCCO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHNNILYNN SCHIMANSKY CRNA

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 45TH ST
WEST PALM BEACH FL
33407-2413
US

IV. Provider business mailing address

3716 MCKINLEY ST
HOLLYWOOD FL
33021-4943
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6300
  • Fax:
Mailing address:
  • Phone: 954-391-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN3232392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: