MEDICARE: MR. ENRICO ESPANOL TOBIAS CRNA FNP

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	079661	TX
2	363LF0000X	Family Nurse Practitioner	RN093092	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00827797	OTHER	TX	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	89053U	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1497925507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ENRICO ESPANOL TOBIAS CRNA FNP

Provider Business Mailing Address
First Line	:	395 STOCKHOLM ST
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4007
Country	:	US
Telephone Number	:	832-763-2906
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 STOCKHOLM ST
Second Line	:	APT 2
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4007
Country	:	US
Telephone Number	:	832-763-2906
Fax Number	:

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

Provider Enumeration Date	:	03/04/2008
Last Update Date	:	11/11/2013

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