Healthcare Provider Details

I. General information

NPI: 1477644169
Provider Name (Legal Business Name): JAY A YAUDEGIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY A A CRNA

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S PINELLAS AVE
TARPON SPRINGS FL
34689-1955
US

IV. Provider business mailing address

120 LIVE OAK LN
LARGO FL
33770-2606
US

V. Phone/Fax

Practice location:
  • Phone: 727-937-6020
  • Fax: 727-934-1250
Mailing address:
  • Phone: 727-584-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9241764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: