Provider Demographics
NPI:1508527755
Name:RICKETTS, LINA (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18117 BISCAYNE BLVD
Mailing Address - Street 2:PMB 61108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:954-649-8393
Mailing Address - Fax:
Practice Address - Street 1:1301 15TH AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3821
Practice Address - Country:US
Practice Address - Phone:701-774-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-09
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9445925163WC0200X
OR202212709RN163WC0200X
WV113936367500000X
OR202213324CRNA-P367500000X
FL11017420367500000X
TXAPRN1071214367500000X
NDR52096367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine