Provider Demographics
NPI:1780630715
Name:SPANN, JUDITH ELAINE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELAINE
Last Name:SPANN
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 1:5731 HARBORAGE DR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4551
Mailing Address - Country:US
Mailing Address - Phone:239-691-5750
Mailing Address - Fax:239-275-0503
Practice Address - Street 1:5731 HARBORAGE DR
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4551
Practice Address - Country:US
Practice Address - Phone:239-267-2523
Practice Address - Fax:239-466-5108
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL050270367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2546Medicare ID - Type Unspecified