=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407827421
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY JEAN BORDEN CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2006
-----------------------------------------------------
Last Update Date | 03/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11161 HEALTH PARK BLVD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34110-5730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-234-2620
-----------------------------------------------------
Fax | 239-234-2622
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7740 HAVERHILL CT
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34104-9483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-877-7433
-----------------------------------------------------
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 | ARNP9221160
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN9221160
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------