Provider Demographics
NPI:1184683054
Name:SCHRADER, CHARLES GERALD (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:GERALD
Last Name:SCHRADER
Suffix:
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:PO BOX 862811
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2811
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:711 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6058
Practice Address - Country:US
Practice Address - Phone:813-654-7111
Practice Address - Fax:813-654-3347
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2034732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL430026095OtherRAILROAD MEDICARE
FLG1060OtherBCBS
FL301556400Medicaid
FLG1060ZMedicare ID - Type Unspecified
FLG1060ZMedicare PIN