Provider Demographics
NPI:1831144823
Name:MASTRAPA, JORGE L (CRNA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:L
Last Name:MASTRAPA
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 1:92 WEST MILLER ST.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2032
Mailing Address - Country:US
Mailing Address - Phone:407-649-9111
Mailing Address - Fax:321-841-4603
Practice Address - Street 1:92 WEST MILLER ST.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:407-649-9111
Practice Address - Fax:321-841-4603
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3337822367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304949300Medicaid
FLG2518OtherBCBS
FLE2215XMedicare PIN
FLE2215YMedicare PIN