MEDICARE: MR. EUGENIO CAROLINO 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	8790	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9071	OTHER	TN	OMNI
2	191848	OTHER	TN	BETTER HEALTH
3	36832	OTHER	TN	TLC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	4134153	OTHER	TN	BLUE CROSS

General Provider Information

NPI Number	:	1710944517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENIO CAROLINO CRNA

Provider Business Mailing Address
First Line	:	4080 LOCH MEADE DR
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-9368
Country	:	US
Telephone Number	:	901-388-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1068 CRESTHAVEN RD
Second Line	:	SUITE 150
City	:	MEMPHIS
State	:	TN
Zip	:	38119-0800
Country	:	US
Telephone Number	:	901-682-6828
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	10/27/2016

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