Provider Demographics
NPI:1043579949
Name:NIMBLE ANESTHESIA, LLC
Entity Type:Organization
Organization Name:NIMBLE ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LINCOLN
Authorized Official - Last Name:UMANA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:850-544-9700
Mailing Address - Street 1:1238 SKIP WELLS CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-1064
Mailing Address - Country:US
Mailing Address - Phone:850-544-9700
Mailing Address - Fax:
Practice Address - Street 1:2030 FLEISCHMANN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4599
Practice Address - Country:US
Practice Address - Phone:850-544-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9241655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty