MEDICARE: EVELYN V SANTIAGO GONZALEZ CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9253474	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN9253474	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053621292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN V SANTIAGO GONZALEZ CRNA

Provider Business Mailing Address
First Line	:	1329 SW 16TH ST RM 2232
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-733-0485
Fax Number	:

Provider Business Practice Location Address
First Line	:	1545 HAND AVE STE A1
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1140
Country	:	US
Telephone Number	:	386-274-2977
Fax Number	:	386-274-2997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	04/29/2021

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Directions to “ EVELYN V SANTIAGO GONZALEZ CRNA” Practice Location

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