1114994126 NPI number — VICTORIA M TRAMAZZO CRNA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114994126 NPI number — VICTORIA M TRAMAZZO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAMAZZO
Provider First Name:
VICTORIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLASH
Provider Other First Name:
VICTORIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114994126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 W COMMERCIAL BLVD STE 4 AND 5
Provider Second Line Business Mailing Address:
ANESCO NORTH BROWARD LLC
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33309-3320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-485-5666
Provider Business Mailing Address Fax Number:
954-484-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6401 NORTH FEDERAL HIGHWAY
Provider Second Line Business Practice Location Address:
IMPERIAL POINT MED CENTER
Provider Business Practice Location Address City Name:
FT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-776-8500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP3155752 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306348800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102489300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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