Healthcare Provider Details

I. General information

NPI: 1215414073
Provider Name (Legal Business Name): KATHLEEN M FISCHETTI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATHLEEN ROUISSE

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608
US

IV. Provider business mailing address

9424 SW 56TH PL
GAINESVILLE FL
32608-4332
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 727-488-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9355686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: