Provider Demographics
NPI:1154627107
Name:BALDEV, NATALLIA MICHAILOVNA (CRNA)
Entity Type:Individual
Prefix:
First Name:NATALLIA
Middle Name:MICHAILOVNA
Last Name:BALDEV
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 1:1670 EAGLE HARBOR PKWY
Mailing Address - Street 2:#B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4820
Mailing Address - Country:US
Mailing Address - Phone:904-644-0700
Mailing Address - Fax:904-644-0759
Practice Address - Street 1:1670 EAGLE HARBOR PKWY
Practice Address - Street 2:#B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-4820
Practice Address - Country:US
Practice Address - Phone:904-644-0700
Practice Address - Fax:904-644-0759
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9246856367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106679AMedicaid
FL0032105-00Medicaid
FLEQ497ZMedicare PIN