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General NPI Number Information
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NPI Number | 1760547145
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Entity Type | Individual
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Provider Name | DERREL CORVETTE HOOKER CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8330 LAKEWOOD RANCH BLVD
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City | BRADENTON
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State | FL
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Zip | 34202-5174
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Country | US
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Telephone | 941-745-6829
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 863295
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City | ORLANDO
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State | FL
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Zip | 32886-3295
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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 | ANT9193963
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License Number State | FL
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