Provider Demographics
NPI:1700368057
Name:GONZALEZ ANDUJAR, LUISET (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LUISET
Middle Name:
Last Name:GONZALEZ ANDUJAR
Suffix:
Gender:F
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:#27 CALLE BENIGNO NATER LAS GRANJAS
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-249-1056
Mailing Address - Fax:
Practice Address - Street 1:2820 BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-4760
Practice Address - Country:US
Practice Address - Phone:813-287-5718
Practice Address - Fax:813-287-5728
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL105548367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105548OtherCRNA