Provider Demographics
NPI:1376876557
Name:MESA BATISTA, AMNIEL (CRNA)
Entity Type:Individual
Prefix:
First Name:AMNIEL
Middle Name:
Last Name:MESA BATISTA
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 1:14474 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6637
Mailing Address - Country:US
Mailing Address - Phone:786-222-9785
Mailing Address - Fax:
Practice Address - Street 1:14474 SW 174TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6637
Practice Address - Country:US
Practice Address - Phone:786-222-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL367500000XMedicare PIN