Basic Information
| Provider Information | |||||||||
| NPI: | 1184835571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITZOVA-VLADINOV | ||||||||
| FirstName: | GRETA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 816759 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330810759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549642450 | ||||||||
| FaxNumber: | 9549646084 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742345 | ||||||||
| FaxNumber: | 9549646084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | ARNP3419182 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 308389600 | 05 | FL | MEDICAID |