Provider Demographics
NPI:1073195178
Name:GAVARRETE, EDWIN BLADIMIR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:BLADIMIR
Last Name:GAVARRETE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:VLADIMIR
Other - Last Name:GAVARRETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 919330
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9330
Mailing Address - Country:US
Mailing Address - Phone:866-444-0850
Mailing Address - Fax:941-269-4426
Practice Address - Street 1:123 BAPTIST WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2254
Practice Address - Country:US
Practice Address - Phone:850-434-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1042492367500000X
FLAPRN11030612367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered