Provider Demographics
NPI:1902058100
Name:LIBERMAN, JACQUELINE SONJA (CRNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SONJA
Last Name:LIBERMAN
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 1:9333 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1778
Mailing Address - Country:US
Mailing Address - Phone:305-256-5267
Mailing Address - Fax:
Practice Address - Street 1:9333 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1778
Practice Address - Country:US
Practice Address - Phone:305-256-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9278172163WC0200X
FLARNP9278172367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine