Provider Demographics
NPI:1497925507
Name:TOBIAS, ENRICO ESPANOL (CRNA FNP)
Entity Type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:ESPANOL
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:CRNA FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 STOCKHOLM ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4007
Mailing Address - Country:US
Mailing Address - Phone:832-763-2906
Mailing Address - Fax:
Practice Address - Street 1:395 STOCKHOLM ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4007
Practice Address - Country:US
Practice Address - Phone:832-763-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX079661367500000X
TXRN093092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2100815Medicaid
TX195369701Medicaid
TXP00827797OtherRAILROAD MEDICARE
TX89053UOtherBLUE CROSS BLUE SHIELD
TX8L0926Medicare PIN