Organization
DEDRA HERN CRNA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEDRA HERN CRNA (PRESIDENT)
(813) 215-4960
Entity
Organization
Contact information
Practice address
1601 38TH AVE N, ST PETERSBURG, FL 33713-1926
(317) 614-9863
(844) 876-0873
Mailing address
PO BOX 850001 DEPT 0451, ORLANDO, FL 32885-0451
(855) 543-5604
(855) 679-5160
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP2702392
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
306290200
—
FL
01
—
DC1392
RAILROAD MEDICARE
FL
01
—
G9055
FL BLUE CROSS
FL
Enumeration date
12/14/2006
Last updated
02/16/2017
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