Healthcare Provider Details

I. General information

NPI: 1033163464
Provider Name (Legal Business Name): LAKE COUNTY ANESTHESIA ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

PO BOX 917756
ORLANDO FL
32891-7756
US

V. Phone/Fax

Practice location:
  • Phone: 352-867-8898
  • Fax: 352-732-6282
Mailing address:
  • Phone: 352-867-8898
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD GIOVANELLI
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 352-867-8898