Provider Demographics
NPI:1578537130
Name:HERMAN, AMY JANE (CRNA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:HERMAN
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 1:166 MARS LN
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6312
Mailing Address - Country:US
Mailing Address - Phone:305-293-9921
Mailing Address - Fax:
Practice Address - Street 1:3641 S MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4205
Practice Address - Country:US
Practice Address - Phone:305-854-0302
Practice Address - Fax:305-854-0308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL857412367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G2139ZMedicare ID - Type Unspecified