Provider Demographics
NPI:1588682363
Name:EHRHARDT, VICKI C (CRNA)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:C
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:KAY COLLIER
Other - Last Name:EHRHARDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1329 SW 16TH ST RM 2232
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1128
Mailing Address - Country:US
Mailing Address - Phone:352-559-5051
Mailing Address - Fax:
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-1744
Practice Address - Fax:386-274-1644
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1016072367500000X
FLAPRN1016072367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG0428Medicare ID - Type Unspecified