Provider Demographics
NPI:1487620159
Name:GOLDWASSER, REBECCA ANNE (CRNA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:GOLDWASSER
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 1:8483 STABLES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7265
Mailing Address - Country:US
Mailing Address - Phone:904-233-0680
Mailing Address - Fax:904-619-1080
Practice Address - Street 1:1564 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4521
Practice Address - Country:US
Practice Address - Phone:904-264-0400
Practice Address - Fax:904-264-0401
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9171583367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306765300Medicaid