Healthcare Provider Details

I. General information

NPI: 1538257613
Provider Name (Legal Business Name): JENNIFER R ANTHONY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 AVENUE 'B' NW
WINTER HAVEN FL
33881-4651
US

IV. Provider business mailing address

PO BOX 917110
ORLANDO FL
32891-7110
US

V. Phone/Fax

Practice location:
  • Phone: 863-291-4000
  • Fax:
Mailing address:
  • Phone: 800-901-2102
  • Fax: 423-892-5838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9311432
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number075475 CRNA
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: