1376534701 NPI number — MICHAEL RICHARD ORLANDO CRNA

Table of content: MICHAEL RICHARD ORLANDO CRNA (NPI 1376534701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376534701 NPI number — MICHAEL RICHARD ORLANDO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORLANDO
Provider First Name:
MICHAEL
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376534701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1336 CREEKSIDE BLVD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-261-1158
Provider Business Mailing Address Fax Number:
239-261-4232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 9TH STREET NORTH
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-261-1158
Provider Business Practice Location Address Fax Number:
239-261-4232
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  ARNP 1937912 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G3430 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 306109400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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