Provider Demographics
NPI: | 1174560478 |
---|---|
Name: | PEREZ, ERNESTO CARIDAD (CRNA) |
Entity type: | Individual |
Prefix: | |
First Name: | ERNESTO |
Middle Name: | CARIDAD |
Last Name: | PEREZ |
Suffix: | |
Gender: | M |
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: | 504 N REO ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TAMPA |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33609-1013 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-549-2134 |
Mailing Address - Fax: | 813-864-4436 |
Practice Address - Street 1: | 4726 N HABANA AVE STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33614-7144 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-549-2134 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-02 |
Last Update Date: | 2019-02-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ARNP9171866 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
P00465669 | Other | RAILROAD -BAYFRONT ANESTHESIA SERVICE PA GRP | |
FL | 305244300 | Medicaid | |
FL | G1903W | Medicare ID - Type Unspecified | |
FL | 305244300 | Medicaid |