Provider Demographics
NPI:1396713293
Name:COHEN, JEFFREY B (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:COHEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 S OAKLAND FOREST DR
Mailing Address - Street 2:UNIT 2403
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-7530
Mailing Address - Country:US
Mailing Address - Phone:305-975-6840
Mailing Address - Fax:
Practice Address - Street 1:2840 S OAKLAND FOREST DR
Practice Address - Street 2:UNIT 2403
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-7530
Practice Address - Country:US
Practice Address - Phone:305-975-6840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2802782367500000X
NY640034-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302806200Medicaid
FL302806200Medicaid