1316913320 NPI number — REBECCA BECKER CRNA

Table of content: REBECCA BECKER CRNA (NPI 1316913320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316913320 NPI number — REBECCA BECKER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKER
Provider First Name:
REBECCA
Provider Middle Name:
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:
CANTOR
Provider Other First Name:
REBECCA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316913320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2013
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
Provider Second Line Business Mailing Address:
C/O 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:
33309-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-485-5666
Provider Business Mailing Address Fax Number:
957-484-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CORAL SPRINGS DR
Provider Second Line Business Practice Location Address:
C/O 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:
33065-3873
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:
02/28/2006

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:  ARNP1797752 , 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: 034796500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".