=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013289552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY M. NAZWORTH CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2012
-----------------------------------------------------
Last Update Date | 03/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7111 FAIRWAY DRIVE, SUITE 450 PALMETTO ANESTHESIA SPECIALISTS, LLC
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-799-3552
-----------------------------------------------------
Fax | 561-799-3527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3628 SW 22ND ST
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-4246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-292-9280
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | ARNP9219270
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------