Provider Demographics
NPI:1750686465
Name:MYERS, MARISSA FRANCIS (CRNA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:FRANCIS
Last Name:MYERS
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 1:2351 SW 37TH AVE PH 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3072
Mailing Address - Country:US
Mailing Address - Phone:248-797-0514
Mailing Address - Fax:
Practice Address - Street 1:2351 SW 37TH AVE PH 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3072
Practice Address - Country:US
Practice Address - Phone:248-797-0514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9240231367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003205700Medicaid
FL87322OtherNBCRNA