Healthcare Provider Details

I. General information

NPI: 1124258280
Provider Name (Legal Business Name): CHARLOTTE JOYCE FAESSLER SANCHEZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 ULMERTON RD STE 450
CLEARWATER FL
33762-2300
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 727-573-7777
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9387470
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05830
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: