Basic Information
Provider Information
NPI: 1942454509
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLE
FirstName: CHRISTINA
MiddleName: M
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12161 KEN ADAMS WAY
Address2: SUITE 182
City: WELLINGTON
State: FL
PostalCode: 334143194
CountryCode: US
TelephoneNumber: 5617984221
FaxNumber: 5617984201
Practice Location
Address1: 1613 HARRISON PKWY
Address2:  
City: SUNRISE
State: FL
PostalCode: 333232896
CountryCode: US
TelephoneNumber: 9548382587
FaxNumber: 9548580116
Other Information
ProviderEnumerationDate: 11/10/2008
LastUpdateDate: 09/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP2939602FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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