Individual
NIT KHAMVONGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3500 US HIGHWAY 1, VERO BEACH, FL 32960-4511
(772) 299-1404
(772) 299-1455
Mailing address
3500 US HIGHWAY 1, VERO BEACH, FL 32960-4511
(772) 299-1404
(772) 299-1455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9232218
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9232218
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307376900
—
FL
Enumeration date
09/27/2006
Last updated
06/23/2021
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