Provider Demographics
NPI:1114917333
Name:LUGO, EDGARDO E (CRNA, MS)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:E
Last Name:LUGO
Suffix:
Gender:M
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 EVEREST PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3283
Mailing Address - Country:US
Mailing Address - Phone:787-408-0676
Mailing Address - Fax:
Practice Address - Street 1:1709 EVEREST PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3283
Practice Address - Country:US
Practice Address - Phone:787-408-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3377192367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered