Provider Demographics
NPI:1487643128
Name:REY, ELLEN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:REY
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 1:1110 SW 152ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2206
Mailing Address - Country:US
Mailing Address - Phone:954-450-2127
Mailing Address - Fax:954-450-0124
Practice Address - Street 1:1110 SW 152ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2206
Practice Address - Country:US
Practice Address - Phone:954-450-2127
Practice Address - Fax:954-450-0124
Is Sole Proprietor?:No
Enumeration Date:2005-10-16
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL907042367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered