1033179320 NPI number — CHERYL A MINGO CRNA

Table of content: CHERYL A MINGO CRNA (NPI 1033179320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033179320 NPI number — CHERYL A MINGO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINGO
Provider First Name:
CHERYL
Provider Middle Name:
A
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033179320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2008
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 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
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:
3000 CORAL HILLS DRIVE
Provider Second Line Business Practice Location Address:
CORAL SPRINGS MEDICAL CENTER
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-344-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

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:  ARNP3389642 , 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)