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NPI Code Detail

MEDICARE: AMY MARIE SURALIS CRNA

MEDICARE: AMY MARIE SURALIS 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
1367500000XCertified Registered Nurse Anesthetist101666NE
2367500000XCertified Registered Nurse AnesthetistAPRN11005568FL
3163W00000XRegistered NurseRN924226FL
4367500000XCertified Registered Nurse AnesthetistRN9294225WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982246328
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY MARIE SURALIS CRNA
Provider Business Mailing Address
First Line : 4446 HENDRICKS AVE STE 366
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-6369
Country : US
Telephone Number : 813-217-2190
Fax Number :
Provider Business Practice Location Address
First Line : 3625 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4207
Country : US
Telephone Number : 904-702-6111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2019
Last Update Date : 01/13/2026

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