Basic Information
| Provider Information | |||||||||
| NPI: | 1427717719 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOOGENDOORN | ||||||||
| FirstName: | GREG | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6722 ALBATROSS LN | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346671672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272715303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14000 FIVAY RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346677103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278192929 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2021 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 9460303 | FL | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 367500000X | 11017233 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.