Provider Demographics
NPI:1003038647
Name:PEVERINI, KRISTA MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:PEVERINI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MARIE
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 51383
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0311
Mailing Address - Country:US
Mailing Address - Phone:803-873-6733
Mailing Address - Fax:941-296-7374
Practice Address - Street 1:3325 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5114
Practice Address - Country:US
Practice Address - Phone:941-552-3480
Practice Address - Fax:941-552-3485
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9284417367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS659ZMedicare PIN