Provider Demographics
NPI:1063691293
Name:TORRES, WANDA IVELLISSE (CRNA)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:IVELLISSE
Last Name:TORRES
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 1:214 PALM BEACH PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4542
Mailing Address - Country:US
Mailing Address - Phone:561-324-9364
Mailing Address - Fax:
Practice Address - Street 1:2815 SOUTH SEACREAST BLVD
Practice Address - Street 2:
Practice Address - City:BOYTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435
Practice Address - Country:US
Practice Address - Phone:561-737-7733
Practice Address - Fax:561-737-4555
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9275524367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1063691293OtherNPI