Healthcare Provider Details

I. General information

NPI: 1295886364
Provider Name (Legal Business Name): PETER NAZARIO-MONTALVO CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER NAZARIO CRNA

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE ROAD
NAPLES FL
34119
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4295
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number076869
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9256070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: