Provider Demographics
NPI:1659355501
Name:ODUM, ORENTA M (CRNA)
Entity Type:Individual
Prefix:
First Name:ORENTA
Middle Name:M
Last Name:ODUM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ORENTA
Other - Middle Name:M
Other - Last Name:ODUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:1220 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7151
Mailing Address - Country:US
Mailing Address - Phone:941-484-5000
Mailing Address - Fax:941-484-4414
Practice Address - Street 1:1220 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7151
Practice Address - Country:US
Practice Address - Phone:941-484-5000
Practice Address - Fax:941-484-4414
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP93046659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB716ZOtherMEDICARE NUMBER
FL002051400Medicaid
FL002051400Medicaid