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General NPI Number Information
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NPI Number | 1447600184
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Entity Type | Individual
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Provider Name | ERICA HUMPHREY POWELL CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 1000 WATERMAN WAY
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City | TAVARES
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State | FL
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Zip | 32778-5266
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Country | US
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Telephone | 321-422-7156
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Fax |
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Provider Business Mailing Address
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Address Line | 5746 ANSLEY WAY
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City | MOUNT DORA
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State | FL
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Zip | 32757-8002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 110372
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9366265
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License Number State | FL
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