1780721282 NPI number — MS. KATHY JEAN CIBULA CRNA

Table of content: MS. KATHY JEAN CIBULA CRNA (NPI 1780721282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780721282 NPI number — MS. KATHY JEAN CIBULA CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIBULA
Provider First Name:
KATHY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
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:
1780721282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7365 SW 166TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VILLAGE OF PALMETTO BAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33157-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-238-1086
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 NW 12TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-6586
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007

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:  ARNP 832082 , 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)