MEDICARE: MS. JUDITH ELAINE SPANN 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	050270	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	:	1780630715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ELAINE SPANN CRNA

Provider Business Mailing Address
First Line	:	5731 HARBORAGE DR
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33908-4551
Country	:	US
Telephone Number	:	239-691-5750
Fax Number	:	239-275-0503

Provider Business Practice Location Address
First Line	:	5731 HARBORAGE DR
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33908-4551
Country	:	US
Telephone Number	:	239-267-2523
Fax Number	:	239-466-5108

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/06/2008

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