Provider Demographics
NPI:1811003239
Name:PETERFESO, JAMES JOHN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOHN
Last Name:PETERFESO
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:117 7TH ST N UNIT 13
Mailing Address - Street 2:
Mailing Address - City:BRADENTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34217-3311
Mailing Address - Country:US
Mailing Address - Phone:941-778-3857
Mailing Address - Fax:727-391-1049
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1049
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR104309-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered