MEDICARE: ELLIE SPITHOURAKIS CRNA, ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP 1905482	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083846612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLIE SPITHOURAKIS CRNA, ARNP

Provider Business Mailing Address
First Line	:	9530 BLUE STONE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-6719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9530 BLUE STONE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-6719
Country	:	US
Telephone Number	:	239-267-4815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2009
Last Update Date	:	08/16/2009

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