MEDICARE: AMBILI GOPINATHAN NAIR 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	ARNP9367002	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN9367002	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	:	1942730544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBILI GOPINATHAN NAIR CRNA

Provider Business Mailing Address
First Line	:	1329 SW 16TH ST RM 2232
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1128
Country	:	US
Telephone Number	:	352-733-0485
Fax Number	:

Provider Business Practice Location Address
First Line	:	6216 MORNING DRIVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127
Country	:	US
Telephone Number	:	203-807-0178
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/21/2022

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