Provider Demographics
NPI:1336172808
Name:FELDMANN, GARY SCOTT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:SCOTT
Last Name:FELDMANN
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 1:2275 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2342
Mailing Address - Country:US
Mailing Address - Phone:407-870-0573
Mailing Address - Fax:407-870-1859
Practice Address - Street 1:2275 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2342
Practice Address - Country:US
Practice Address - Phone:407-870-0573
Practice Address - Fax:407-870-1859
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1742502367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2510OtherBCBS
FL300359100Medicaid