Healthcare Provider Details

I. General information

NPI: 1306100466
Provider Name (Legal Business Name): KRISHNA CHANDRA PRASAD JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CREEKSIDE BLVD
NAPLES FL
34108-1931
US

IV. Provider business mailing address

14500 JEKYLL ISLAND CT
NAPLES FL
34119-4814
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-1158
  • Fax:
Mailing address:
  • Phone: 239-348-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number90322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: