Healthcare Provider Details

I. General information

NPI: 1710079561
Provider Name (Legal Business Name): PATRICIA L TRAVIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 LITTLE PATUXENT PKWY STE 240
COLUMBIA MD
21044-3540
US

IV. Provider business mailing address

10400 LITTLE PATUXENT PKWY STE 240
COLUMBIA MD
21044-3540
US

V. Phone/Fax

Practice location:
  • Phone: 321-422-7110
  • Fax: 407-667-4338
Mailing address:
  • Phone: 321-422-7110
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC000537
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL60A00284
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: