1477544518 NPI number — EMMA TORRES GONZALEZ CRNA

Table of content: EMMA TORRES GONZALEZ CRNA (NPI 1477544518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477544518 NPI number — EMMA TORRES GONZALEZ CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORRES GONZALEZ
Provider First Name:
EMMA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TORRES
Provider Other First Name:
EMMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477544518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4048 EVANS AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33901-9322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-332-5344
Provider Business Mailing Address Fax Number:
239-332-7246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4048 EVANS AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-9322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-332-5344
Provider Business Practice Location Address Fax Number:
239-332-7246
Provider Enumeration Date:
10/28/2005

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:  ARNP9192101 , 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: G3182 . This is a "BSFL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: G3182Z . This is a "MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 305100500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 430077599 . This is a "MCRR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 305100500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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