MEDICARE: KARLA S SHERUBAWON 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
1	367500000X	Certified Registered Nurse Anesthetist	APRN9277236	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700218369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA S SHERUBAWON CRNA

Provider Business Mailing Address
First Line	:	2169 PLANTATION OAK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4869
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N DEAN RD STE 102
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-3710
Country	:	US
Telephone Number	:	407-506-0006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2013
Last Update Date	:	07/12/2022

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