Provider Demographics
NPI:1851318794
Name:NYDAM, ROBIN LEAH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LEAH
Last Name:NYDAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:330 OAKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-2010
Mailing Address - Country:US
Mailing Address - Phone:941-475-9293
Mailing Address - Fax:941-475-9293
Practice Address - Street 1:540 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2900
Practice Address - Country:US
Practice Address - Phone:941-483-7682
Practice Address - Fax:941-483-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9187820367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered