=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700505120
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRISTOY HENDRALIND CRNA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2022
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 MEMORIAL MEDICAL PKWY
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-5167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-231-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1312 LOFTWEDGE CIR
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32124-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-392-9168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APRN11021585
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------