1497068431 NPI number — LIZZETTE TRIANA WARREN CRNA

Table of content: LIZZETTE TRIANA WARREN CRNA (NPI 1497068431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497068431 NPI number — LIZZETTE TRIANA WARREN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
LIZZETTE
Provider Middle Name:
TRIANA
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:
RITTBERGER
Provider Other First Name:
LIZZETTE
Provider Other Middle Name:
TRIANA
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:
1497068431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 HARRISON PKWY
Provider Second Line Business Mailing Address:
SUITE 200, MAILSTOP SH-9A
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:
954-851-1746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7800 SHERIDAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-962-9650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2010

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:  ARNP9218932 , 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: 002555700 . 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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