Healthcare Provider Details

I. General information

NPI: 1669653986
Provider Name (Legal Business Name): SANDRA CRISTINA DA SILVA BONFIM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

IV. Provider business mailing address

12230 W FOREST HILL BLVD STE #182
WELLINGTON FL
33414-5700
US

V. Phone/Fax

Practice location:
  • Phone: 800-394-4445
  • Fax: 706-650-1034
Mailing address:
  • Phone: 561-798-4221
  • Fax: 561-798-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9268743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: