Provider Demographics
NPI:1932246907
Name:GIGNAC, KELLY CHRISTINE (CRNA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:GIGNAC
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 1:1220 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-7151
Mailing Address - Country:US
Mailing Address - Phone:941-442-5000
Mailing Address - Fax:
Practice Address - Street 1:1220 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7151
Practice Address - Country:US
Practice Address - Phone:941-484-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9297235367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051589Medicaid
SCAN1722Medicaid
NC430073628OtherRAILROAD-MEDICARE
NC430073628OtherRAILROAD-MEDICARE
NC2603681Medicare PIN