Healthcare Provider Details

I. General information

NPI: 1831899467
Provider Name (Legal Business Name): STEPHANIE MENDOZA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 09/29/2026
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4159 AFTON CT
WEST PALM BEACH FL
33409-7820
US

IV. Provider business mailing address

4159 AFTON CT
WEST PALM BEACH FL
33409-7820
US

V. Phone/Fax

Practice location:
  • Phone: 561-225-9229
  • Fax:
Mailing address:
  • Phone: 561-225-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1211524
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: