Healthcare Provider Details

I. General information

NPI: 1235777236
Provider Name (Legal Business Name): CHRISTIAN AARON RECOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W NEWBERRY RD
GAINESVILLE FL
32605-4309
US

IV. Provider business mailing address

5730 NW 27TH ST
GAINESVILLE FL
32653-1943
US

V. Phone/Fax

Practice location:
  • Phone: 203-258-2756
  • Fax:
Mailing address:
  • Phone: 203-258-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11005380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: