Healthcare Provider Details

I. General information

NPI: 1295712628
Provider Name (Legal Business Name): TRACY A DIGIACOMO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACY T TROIANI CRNA

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 MEDICAL BLVD SUITE 201 PREMIER ENDOSCOPY
NAPLES FL
34110
US

IV. Provider business mailing address

4740 ENTERPRISE AVE STE 205
NAPLES FL
34104-7058
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-6201
  • Fax:
Mailing address:
  • Phone: 239-404-0058
  • Fax: 239-774-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number616594
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN291599L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3163752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: