MEDICARE: JAY SPENCER ORELLANA 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	APRN11030371	FL

General Provider Information

NPI Number	:	1598446510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY SPENCER ORELLANA CRNA

Provider Business Mailing Address
First Line	:	8599 A C SKINNER PKWY UNIT 1311
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0855
Country	:	US
Telephone Number	:	904-607-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	8599 A C SKINNER PKWY UNIT 1315
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0855
Country	:	US
Telephone Number	:	904-607-3937
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	02/26/2024

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