Healthcare Provider Details

I. General information

NPI: 1891035556
Provider Name (Legal Business Name): HAYLEY R FERGUSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 GALL BLVD
ZEPHYRHILLS FL
33541-1347
US

IV. Provider business mailing address

PO BOX 402447
ATLANTA GA
30384-2447
US

V. Phone/Fax

Practice location:
  • Phone: 813-783-6119
  • Fax:
Mailing address:
  • Phone: 877-509-3653
  • Fax: 913-341-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9218367
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: