Provider Demographics
NPI:1356304992
Name:IMLER, GINETTE LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:GINETTE
Middle Name:LYNN
Last Name:IMLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:GINETTE
Other - Middle Name:LYNN
Other - Last Name:HELSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6015 POINTE WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5532
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:6015 POINTE WEST BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5532
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-761-0712
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3146932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00949716OtherRAIL ROAD MEDICARE
FL306050100Medicaid
Y040EBMedicare ID - Type Unspecified