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General NPI Number Information
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NPI Number | 1679635924
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Entity Type | Organization
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Legal Business Name | DEDRA HERN CRNA LLC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 1601 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-1926
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Country | US
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Telephone | 317-614-9863
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Fax | 844-876-0873
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Provider Business Mailing Address
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Address Line | PO BOX 850001 DEPT 0451
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City | ORLANDO
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State | FL
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Zip | 32885-0451
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Country | US
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Telephone | 855-543-5604
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Fax | 855-679-5160
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEDRA HERN
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Credential | CRNA
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Telephone | 813-215-4960
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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 | ARNP2702392
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License Number State | FL
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