Provider Demographics
NPI:1053308080
Name:SOMMER, CATHY (CRNA)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:SOMMER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11909 JENNIFER WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1002
Mailing Address - Country:US
Mailing Address - Phone:954-450-5821
Mailing Address - Fax:
Practice Address - Street 1:1613 NW 136TH AVE
Practice Address - Street 2:#200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2853
Practice Address - Country:US
Practice Address - Phone:954-838-2502
Practice Address - Fax:954-851-1758
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1087166367500000X
FL9247004367500000X
VT101-0034357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY740020056Medicaid
KY740020056Medicaid
KY1269963Medicare ID - Type Unspecified