Provider Demographics
NPI:1609821669
Name:STAMATIADES, FOTINI ROUSSOS (CRNA)
Entity Type:Individual
Prefix:
First Name:FOTINI
Middle Name:ROUSSOS
Last Name:STAMATIADES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:FOTINI
Other - Middle Name:
Other - Last Name:ROUSSOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:76 PEACHTREE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3395
Mailing Address - Country:US
Mailing Address - Phone:828-274-3477
Mailing Address - Fax:828-274-7407
Practice Address - Street 1:76 PEACHTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3395
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC072365367500000X
FL3391292367500000X
NC4858367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609821669Medicaid
FL306896000Medicaid
FLG3773ZMedicare ID - Type UnspecifiedFGTBA