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General NPI Number Information
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NPI Number | 1053529131
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Entity Type | Individual
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Provider Name | JANET RUSTIA CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 6138 KENNERLY RD STE 201
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4395
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Country | US
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Telephone | 904-208-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 808 S BLACK CHERRY DR
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City | SAINT JOHNS
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State | FL
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Zip | 32259-4099
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Country | US
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Telephone | 908-415-0202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26N009399700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | ARNP9287785
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP9287785
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License Number State | FL
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