Provider Demographics
NPI:1083824445
Name:TOLOSA, MANUEL E (CRNA)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:E
Last Name:TOLOSA
Suffix:
Gender:M
Credentials:CRNA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:671 WINYAH DR
Mailing Address - Street 2:DEPARTMENT OF NURSE ANESTHESIA
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1226
Mailing Address - Country:US
Mailing Address - Phone:407-303-9331
Mailing Address - Fax:407-303-9578
Practice Address - Street 1:671 WINYAH DR
Practice Address - Street 2:DEPARTMENT OF NURSE ANESTHESIA
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1226
Practice Address - Country:US
Practice Address - Phone:407-303-9331
Practice Address - Fax:407-303-9578
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN173215367500000X
FLARNP 9321827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered