Provider Demographics
NPI:1942855333
Name:DUTKOWSKY, DEENA ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:ANNE
Last Name:DUTKOWSKY
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 1:17416 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1931
Mailing Address - Country:US
Mailing Address - Phone:813-447-1024
Mailing Address - Fax:
Practice Address - Street 1:17416 BROWN RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1931
Practice Address - Country:US
Practice Address - Phone:813-447-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLR9384852163W00000X
FLAPRN11005489367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11005489OtherFLORIDA BOARD OF NURSING