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General NPI Number Information
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NPI Number | 1730650698
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Entity Type | Individual
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Provider Name | GINA FASOLO CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 1525 W CYPRESS CREEK ROAD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309
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Country | US
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Telephone | 201-615-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 10 NORTH ST
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City | ELMWOOD PARK
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State | NJ
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Zip | 07407-2246
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Country | US
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Telephone | 201-615-6601
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN11007198
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 647022
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License Number State | NY
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