MEDICARE: JONATHAN DAVID EBERHARDT CRNA

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	APRN9268926	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	:	1669761243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DAVID EBERHARDT CRNA

Provider Business Mailing Address
First Line	:	10825 DENNINGTON RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8568
Country	:	US
Telephone Number	:	309-696-5880
Fax Number	:	866-665-2702

Provider Business Practice Location Address
First Line	:	10825 DENNINGTON RD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-8568
Country	:	US
Telephone Number	:	309-696-5880
Fax Number	:

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

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	03/20/2026

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