Provider Demographics
NPI:1124007331
Name:GUALTIERE, JANICE (CRNA)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GUALTIERE
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:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-839-2569
Practice Address - Street 1:5540 LINTON BLVD
Practice Address - Street 2:SUITE 258
Practice Address - City:DELRAY BLEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6514
Practice Address - Country:US
Practice Address - Phone:561-498-4440
Practice Address - Fax:954-938-0957
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1642052174400000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034797300Medicaid
FLG0244OtherBCBS OF FLORIDA
FLP00282265OtherMEDICARE RAILROAD
A38297Medicare UPIN
FLP00282265OtherMEDICARE RAILROAD
FLG0244DMedicare ID - Type Unspecified
FLG0244OtherBCBS OF FLORIDA