Provider Demographics
NPI:1093747925
Name:BESS, SANDRA JEAN (CRNA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:BESS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8140
Mailing Address - Country:US
Mailing Address - Phone:321-727-8071
Mailing Address - Fax:
Practice Address - Street 1:625 SANDPIPER CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8140
Practice Address - Country:US
Practice Address - Phone:321-727-8071
Practice Address - Fax:321-727-8071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL023986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1252XMedicare PIN
G1252Medicare UPIN
FL430046961Medicare PIN