Provider Demographics
NPI:1659373207
Name:SALVATICO, GERALD (CRNA)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SALVATICO
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 1:650 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4829
Mailing Address - Country:US
Mailing Address - Phone:386-736-1574
Mailing Address - Fax:386-943-4734
Practice Address - Street 1:650 FOREST LN
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4829
Practice Address - Country:US
Practice Address - Phone:386-736-1574
Practice Address - Fax:386-943-4734
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3578A367500000X
FLARNP 1571672367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74004136Medicaid
FL300770700Medicaid
KY0719630Medicare ID - Type Unspecified
KY74004136Medicaid
KY0943021Medicare ID - Type Unspecified
KY0742517Medicare ID - Type Unspecified
KY0228988Medicare ID - Type Unspecified