Healthcare Provider Details

I. General information

NPI: 1205693504
Provider Name (Legal Business Name): KALIE MARIE COMBASS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-6504
US

IV. Provider business mailing address

1625 NW 19TH CIR
GAINESVILLE FL
32605-4093
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9470541
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11039199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: