Healthcare Provider Details

I. General information

NPI: 1134559479
Provider Name (Legal Business Name): CHRISTINA RUTH PARKS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA RUTH VANCUREN RN

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 OPITZ BLVD
WOODBRIDGE VA
22191
US

IV. Provider business mailing address

1613 HARRISON PKWY SUITE 200, MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 703-670-1313
  • Fax:
Mailing address:
  • Phone: 954-514-4793
  • Fax: 954-514-3915

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 Number0024171404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: