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General NPI Number Information
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NPI Number | 1558964833
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Entity Type | Individual
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Provider Name | PREETHA SAMUEL CRNA
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 05/30/2021
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Provider Practice Location Address
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Address Line | 401 NW 42ND AVE
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City | PLANTATION
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State | FL
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Zip | 33317-2835
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Country | US
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Telephone | 954-587-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 13444 NW 13TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-2718
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Country | US
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Telephone | 305-746-7794
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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 | 11011610
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License Number State | FL
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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 | APRN11011610
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License Number State | FL
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