Healthcare Provider Details

I. General information

NPI: 1609346238
Provider Name (Legal Business Name): KRISTA DANIELLE RAQUET CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA DANIELLE HORD

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD
CHARLOTTE NC
28203
US

IV. Provider business mailing address

2720 SOUTH BLVD APT 116
CHARLOTTE NC
28209-1489
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9404818
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: