Provider Demographics
NPI:1821399494
Name:MASSUCCO, JOHNNILYNN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JOHNNILYNN
Middle Name:
Last Name:MASSUCCO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JOHNNILYNN
Other - Middle Name:
Other - Last Name:SCHIMANSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3716 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-4943
Mailing Address - Country:US
Mailing Address - Phone:954-391-7624
Mailing Address - Fax:
Practice Address - Street 1:901 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-844-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3232392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG00SDOtherBCBS
FLFC258XMedicare PIN