Healthcare Provider Details

I. General information

NPI: 1609256155
Provider Name (Legal Business Name): JOEL PELLOT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 NW 13TH ST STE 101
GAINESVILLE FL
32609-1858
US

IV. Provider business mailing address

COND CAPARRA REAL 254 CARR 2, APT 202
GUAYNABO PR
00966-1905
US

V. Phone/Fax

Practice location:
  • Phone: 787-399-4643
  • Fax:
Mailing address:
  • Phone: 787-399-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9404875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: