Healthcare Provider Details

I. General information

NPI: 1609322502
Provider Name (Legal Business Name): KATRINA LUCAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA ROBERTS CRNA

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 PEACHTREE RD NW #515
ATLANTA GA
30309-5219
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-1745
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN192496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: