=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720011281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RHONDA EDRALINE PICKARD C.R.N.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 04/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 W SAMPLE RD
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-3542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-782-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11031 BAYBREEZE WAY
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-212-2431
-----------------------------------------------------
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 | 0024166881
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------