Provider Demographics
NPI:1376846485
Name:CEJA, NICOLE THERESE (CRNA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESE
Last Name:CEJA
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 1:5606 SKIMMER DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3354
Mailing Address - Country:US
Mailing Address - Phone:401-474-1633
Mailing Address - Fax:
Practice Address - Street 1:6043 WINTHROP COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4272
Practice Address - Country:US
Practice Address - Phone:813-699-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36618367500000X
SC4391367500000X
FLARNP9433127367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered