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General NPI Number Information
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NPI Number | 1992701403
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Entity Type | Individual
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Provider Name | JANE HERZOG CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 95429 BARNWELL RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1698
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Country | US
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Telephone | 904-321-3533
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Fax | 517-787-7365
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Provider Business Mailing Address
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Address Line | 95429 BARNWELL RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1698
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Country | US
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Telephone | 904-321-3533
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Fax | 517-787-7365
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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 | 9271732
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License Number State | FL
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