Provider Demographics
NPI:1003884347
Name:KALYNYCH, NICHOLAS M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:M
Last Name:KALYNYCH
Suffix:
Gender:M
Credentials:CRNA
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Other - Credentials:
Mailing Address - Street 1:690 MAJESTIC EAGLE DR
Mailing Address - Street 2:SUNBELT ANESTHESIA SERVICES,LLC
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0611
Mailing Address - Country:US
Mailing Address - Phone:904-412-2593
Mailing Address - Fax:904-686-1817
Practice Address - Street 1:690 MAJESTIC EAGLE DR
Practice Address - Street 2:SUNBELT ANESTHESIA SERVICES, LLC
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0611
Practice Address - Country:US
Practice Address - Phone:904-412-2593
Practice Address - Fax:904-686-1817
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3014012363L00000X
FL3014012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3034364-00Medicaid
GA000892009AMedicaid
FLG20357OtherBLUE CROSS / BLUE SHIELD NUMBER
FL3034364-00Medicaid
FLE4860XMedicare PIN
FLG20357OtherBLUE CROSS / BLUE SHIELD NUMBER