NPI Code Detail JSON Logo

1295712628 NPI number — TRACY A DIGIACOMO CRNA

NPI Number: 1295712628
Health Care Provider/Practitioner: TRACY A DIGIACOMO CRNA

Information about “1295712628” NPI (TRACY A DIGIACOMO CRNA) exists in 1295712628 in HTML format HTML  |  1295712628 in plain Text format TXT  |  1295712628 in PDF (Portable Document Format) PDF  |  1295712628 in an XML format XML  formats.

NPI Number : 1295712628 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295712628",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DIGIACOMO",
    "FirstName": "TRACY",
    "MiddleName": "A",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CRNA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TROIANI",
    "OtherFirstName": "TRACY",
    "OtherMiddleName": "T",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "CRNA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4740 ENTERPRISE AVE STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NAPLES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "34104-7058",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-404-0058",
    "MailingAddressFaxNumber": "239-774-5691",
    "FirstLinePracticeLocationAddress": "1656 MEDICAL BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 201 PREMIER ENDOSCOPY",
    "PracticeLocationAddressCityName": "NAPLES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34110",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-593-6201",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/28/2005",
    "LastUpdateDate": "03/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "616594",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "RN291599L",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "367500000X",
          "TaxonomyName": "Certified Registered Nurse Anesthetist",
          "LicenseNumber": "3163752",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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