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NPI Code Detail

MEDICARE: MARIANNA ILACHTCHOUK DNP, CRNA

MEDICARE: MARIANNA ILACHTCHOUK DNP, CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN11042394FL
2367500000XCertified Registered Nurse Anesthetist1169676TX

General Provider Information

NPI Number : 1295079564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNA ILACHTCHOUK DNP, CRNA
Provider Business Mailing Address
First Line : 3050 VIRGINIA ST
Second Line :
City : MIAMI
State : FL
Zip : 33133-4524
Country : US
Telephone Number : 916-832-1632
Fax Number :
Provider Business Practice Location Address
First Line : 5030 BRUNSON DR
Second Line :
City : CORAL GABLES
State : FL
Zip : 33146-2412
Country : US
Telephone Number : 916-832-1632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2012
Last Update Date : 02/10/2026

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