Provider Demographics
NPI:1700870391
Name:HERRMANN, LADDEN D (CRNA)
Entity Type:Individual
Prefix:
First Name:LADDEN
Middle Name:D
Last Name:HERRMANN
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 1:1304 SE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-4716
Mailing Address - Country:US
Mailing Address - Phone:352-216-8639
Mailing Address - Fax:
Practice Address - Street 1:1304 SE 46TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480-4716
Practice Address - Country:US
Practice Address - Phone:352-216-8639
Practice Address - Fax:352-873-9726
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9217228367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306502200Medicaid
FL306502200Medicaid