Provider Demographics
NPI:1164761367
Name:GENOTTI, ADRIAN JOHN III (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:JOHN
Last Name:GENOTTI
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 1/2 HERSCHEL ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3301
Mailing Address - Country:US
Mailing Address - Phone:904-866-6711
Mailing Address - Fax:
Practice Address - Street 1:4431 1/2 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3301
Practice Address - Country:US
Practice Address - Phone:904-866-6711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9281093367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered