Provider Demographics
NPI:1053478941
Name:NIEKRO, EMILEE REBECCA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:EMILEE
Middle Name:REBECCA
Last Name:NIEKRO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:EMILEE
Other - Middle Name:REBECCA
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 95004
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-5004
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:863-680-7420
Practice Address - Street 1:1600 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3019
Practice Address - Country:US
Practice Address - Phone:863-680-7000
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT9193506367500000X
FLARNP9193506367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG4238OtherBLUE CROSS BLUE SHIELD
FL308262800Medicaid
FLG4238OtherBLUE CROSS BLUE SHIELD
FLP00397935Medicare PIN
FLAD395ZMedicare PIN