=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902180912
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN LIEBERMAN CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2011
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 DON WICKHAM DR
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-243-9114
-----------------------------------------------------
Fax | 352-243-7822
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1381 CITRUS TOWER BLVD SUITE 104
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-1957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-243-9114
-----------------------------------------------------
Fax | 352-243-7822
-----------------------------------------------------
=====================================================
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 | APRN9261107
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------