Provider Demographics
NPI:1710944517
Name:CAROLINO, EUGENIO (CRNA)
Entity Type:Individual
Prefix:MR
First Name:EUGENIO
Middle Name:
Last Name:CAROLINO
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 1:4080 LOCH MEADE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9368
Mailing Address - Country:US
Mailing Address - Phone:901-388-1919
Mailing Address - Fax:
Practice Address - Street 1:1068 CRESTHAVEN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0800
Practice Address - Country:US
Practice Address - Phone:901-682-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8790367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9071OtherOMNI
TN191848OtherBETTER HEALTH
TN36832OtherTLC
TN3605424Medicaid
TN4134153OtherBLUE CROSS
TN4134153OtherBLUE CROSS
TN9071OtherOMNI