Provider Demographics
NPI:1568421816
Name:SONNTAG, LYNETTE M (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:SONNTAG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:ANESCO NORTH BROWARD
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-485-5666
Mailing Address - Fax:954-484-1651
Practice Address - Street 1:1600 S ANDREWS AVE
Practice Address - Street 2:BROWARD GENERAL MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1670492367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301978100Medicaid
FLG1980XMedicare ID - Type Unspecified
FLG1980YMedicare ID - Type UnspecifiedFOR ANESCO CENTRAL LLC