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General NPI Number Information
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NPI Number | 1780616599
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Entity Type | Individual
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Provider Name | IMKE CASEY CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 1099 CITRUS TOWER BLVD
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City | CLERMONT
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State | FL
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Zip | 34711-1947
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Country | US
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Telephone | 352-404-9467
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1739
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City | MINNEOLA
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State | FL
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Zip | 34755-1739
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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 | ARNP3374332
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License Number State | FL
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