Healthcare Provider Details

I. General information

NPI: 1336820422
Provider Name (Legal Business Name): CRISTINA JASED MENDEZ LUGO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 CYPRESS PKWY
KISSIMMEE FL
34759
US

IV. Provider business mailing address

PO BOX 2104
AGUADA PR
00602-2104
US

V. Phone/Fax

Practice location:
  • Phone: 407-530-2000
  • Fax:
Mailing address:
  • Phone: 787-239-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11022975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: