Provider Demographics
NPI:1548607641
Name:SANCHEZ, JULISSA GISELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:GISELLE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:GISELLE
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100806
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0806
Mailing Address - Country:US
Mailing Address - Phone:407-870-0573
Mailing Address - Fax:
Practice Address - Street 1:2275 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2342
Practice Address - Country:US
Practice Address - Phone:407-870-0573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231978367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered