Provider Demographics
NPI:1417082850
Name:D'AVI, JARED SABER (CRNA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:SABER
Last Name:D'AVI
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 1:1040 INVERNESS AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1913
Mailing Address - Country:US
Mailing Address - Phone:352-281-5889
Mailing Address - Fax:
Practice Address - Street 1:1040 INVERNESS AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1913
Practice Address - Country:US
Practice Address - Phone:352-281-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9174901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00746990OtherMEDICARE RAILROAD