Provider Demographics
NPI:1316756257
Name:LAVILLA, JOSELYNN KRISTEN (CRNA)
Entity type:Individual
Prefix:MISS
First Name:JOSELYNN
Middle Name:KRISTEN
Last Name:LAVILLA
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 1:4934 SW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4904
Mailing Address - Country:US
Mailing Address - Phone:954-433-7689
Mailing Address - Fax:
Practice Address - Street 1:4934 SW 166TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4904
Practice Address - Country:US
Practice Address - Phone:954-433-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL153394367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered