MEDICARE: DANIELLE LYN RUDOFF-PEREZ 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	APRN3410362	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00761061	OTHER	FL	RAILROAD MEDICARE

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
2	G3823	OTHER	FL	BCBS OF FLORIDA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174554372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE LYN RUDOFF-PEREZ CRNA

Provider Business Mailing Address
First Line	:	1874 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5545
Country	:	US
Telephone Number	:	772-337-7676
Fax Number	:	772-223-3605

Provider Business Practice Location Address
First Line	:	1874 SE PORT SAINT LUCIE BLVD
Second Line	:	ANESTHESIA DEPARTMENT
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5545
Country	:	US
Telephone Number	:	772-337-7676
Fax Number	:	772-223-3605

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	12/03/2025

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