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NPI Code Detail

MEDICARE: KELLY DONATELLI CRNA

MEDICARE: KELLY DONATELLI 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
1367500000XCertified Registered Nurse AnesthetistARNP9237289FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RAILROAD MEDICAREOTHERFLP00277773
2BLUE CROSSOTHERFLG3949

General Provider Information

NPI Number : 1437123486
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DONATELLI CRNA
Provider Business Mailing Address
First Line : 3209 ANTICA ST
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-1503
Country : US
Telephone Number : 239-939-2622
Fax Number : 239-939-0151
Provider Business Practice Location Address
First Line : 3949 EVANS AVE
Second Line : STE 102
City : FORT MYERS
State : FL
Zip : 33901-9335
Country : US
Telephone Number : 239-939-2622
Fax Number : 239-939-0151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 08/03/2007

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Directions to “ KELLY DONATELLI CRNA” Practice Location

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