Healthcare Provider Details

I. General information

NPI: 1720119191
Provider Name (Legal Business Name): ANN CATHERINE SIMON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 DUNDEE RD
WINTER HAVEN FL
33884-1166
US

IV. Provider business mailing address

PO BOX 864165
ORLANDO FL
32886-4165
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-8471
  • Fax:
Mailing address:
  • Phone: 317-614-9863
  • Fax: 844-876-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1053702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: