Provider Demographics
NPI:1750704177
Name:LOMBARDO, KASUDA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KASUDA
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KASUDA
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5199 DERBY FOREST LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-1514
Mailing Address - Country:US
Mailing Address - Phone:727-271-3319
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231673367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003143417AMedicaid
FL010543000Medicaid
FLP01489733Medicare PIN
FL010543000Medicaid