Provider Demographics
NPI:1275636144
Name:WHITEAKER, JAIME LOU (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:LOU
Last Name:WHITEAKER
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 1:2861 S DELANEY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2806
Mailing Address - Country:US
Mailing Address - Phone:407-472-5095
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:2861 S DELANEY AVE
Practice Address - Street 2:STE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2806
Practice Address - Country:US
Practice Address - Phone:407-472-5095
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4721A367500000X
KY1108102367500000X
TN14271367500000X
FLARNP1512002367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL430045987OtherRAILROAD MEDICARE
FLG1260ZOtherBLUE SHIELD OF FL
FL430045987OtherRAILROAD MEDICARE
G1260WMedicare PIN