Healthcare Provider Details

I. General information

NPI: 1528649183
Provider Name (Legal Business Name): JOSE L MALDONADO HEVIA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

930 PACIFIC HILLS PT APT B106
COLORADO SPRINGS CO
80906-8448
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax: 352-273-8612
Mailing address:
  • Phone: 939-244-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number12996
License Number StateVI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11028548
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0996440
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: