Basic Information
Provider Information
NPI: 1083684443
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLMAN
FirstName: BECKY
MiddleName: JO
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 551420
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333551420
CountryCode: US
TelephoneNumber: 8002433839
FaxNumber: 8558514405
Practice Location
Address1: 4725 N. FEDERAL HIGHWAY
Address2:  
City: FORT LAUDERDALE
State: FL
PostalCode: 333084603
CountryCode: US
TelephoneNumber: 9544935005
FaxNumber: 9549380957
Other Information
ProviderEnumerationDate: 01/26/2006
LastUpdateDate: 05/09/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP3303402FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home