Provider Demographics
NPI:1841614401
Name:KRUMBHOLZ, LOREN (CRNA)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:KRUMBHOLZ
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 1:1500 RICARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6845
Mailing Address - Country:US
Mailing Address - Phone:239-443-8070
Mailing Address - Fax:
Practice Address - Street 1:1500 RICARDO AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6845
Practice Address - Country:US
Practice Address - Phone:239-443-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9265771163W00000X
FLAPRN9265771367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse