Provider Demographics
NPI:1255353132
Name:THORSSON, MARY M (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:THORSSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:CERASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O BOX 452317
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:
Practice Address - Street 1:2173A CENTERVILLE PLACE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-385-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3378382163W00000X
FLARNP3378382367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse